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How ob.gyn. programs provide abortion training post Dobbs
to fulfill required clinical rotations in the procedure.
The Accreditation Council for Graduate Medical Education requires ob.gyn. residents – unless they have a religious or moral exemption – to undergo abortion training to complete their programs. In states with bans or restrictions on family planning services or abortions, resident training must be received at institutions that are out of state.
Some residency programs are just beginning to coordinate out-of-state training, while others are further along in their offerings. There’s no formal matching process, and it remains unclear who will cover the costs of residents training elsewhere for a month.
These uncertainties, along with lack of coordination about malpractice, clinical rotations, and limited faculty, leave some program directors skeptical they’ll be able to keep up with demand for out-of-state slots. They are also wary of harming their own residents’ educational and clinical opportunities.
A 3rd-year ob.gyn. resident, who didn’t want to give her name or residency program for fear of backlash against her home institution, told this news organization that the Catholic-affiliated site is trying to avoid drawing attention to its minimal abortion training in a restrictive Midwest state. She knew after the Supreme Court’s decision in Dobbs v. Jackson she’d have to look outside the program for more complex abortion training.
While she could learn dilation and curettage or other first-trimester or early–second-trimester procedures at the Midwest program, she said she couldn’t learn dilation and evacuation.
A mentor at her program connected her with a residency program at the University of New Mexico, where she recently started a 5-week family planning rotation. She is the first out-of-state resident hosted by UNM. Currently, UNM has six ob.gyn. residents per class year, for a total of 36, and six family planning fellows.
The ob.gyn. resident is staying with a friend at no cost, and her home institution still pays her salary. But she still must pay the mortgage on a home she can’t live in while away and misses being part of a community where she’s built a life over the past 2 years.
“There’s a part of you that’s just angry that you can’t do this for the women ... in your state,” she said. “Unfortunately, there isn’t a formalized program for ob.gyn. residents interested in more advanced training to be matched with a program that has the ability to offer that training. It’s very much a word-of-mouth and who-you-know situation. For people without those connections, it can be difficult to obtain this training unless they are interested in a formal fellowship.”
This year, about 1,500 ob.gyn. residents matched into 280 residency programs, according to the National Residency Matching Program.
Alyssa Colwill, MD, assistant professor of obstetrics and gynecology at Oregon Health and Science University and director of the ob.gyn. Ryan Residency Program at OHSU, estimated that 1,000 ob.gyn. residents per year will seek out-of-state abortion training. The estimate is based on the number of residents in programs in states with restrictions.
The Ryan Program, which began in 1999, helps ob.gyn. residency programs provide training in abortion and contraception care (family planning) as a required rotation.
Connecting programs
Ryan-affiliated residencies have been helping connect programs in states with abortion bans and restrictions to programs in states with more liberal laws.
Twelve of the 100 Ryan programs sent residents out of state in the past academic year, and 15 will follow this year. More are expected soon, said Kristin Simonson, MA, director of programs and operations at the Ryan Residency Program, headquartered at the Bixby Center for Global Reproductive Health at the University of California, San Francisco.
Before the Dobbs decision, very few programs considered next steps to train ob.gyn. residents if abortions became illegal, Ms. Simonson said. “I think a lot of people just kind of were waiting and seeing ... and hoping that they wouldn’t have to make any drastic plans. It was hard to motivate people to have a plan B ready to go,” she said.
“Almost all of us working in this field had a really bad feeling,” said Courtney G. Forbis, MD, UNM assistant professor of ob.gyn. and Ryan Residency director. She and colleagues began planning for the future months ahead of the court decision. But the program wasn’t able to begin accepting out-of-state residents until now, she said. “We are trying to use this experience to see what we can accommodate in the future.”
OHSU also began planning for alternative training when it learned of the leaked Supreme Court decision, Dr. Colwill said. “We decided that we had the bandwidth and opportunity to train more individuals that were going to lose access to services and educational opportunities,” she said.
The university ran a 4-week test rotation last fall. So far, six residents and one fellow have come from out of the state, said Dr. Colwill. OHSU hopes to have 10 more in the coming year. The out-of-state learners will join 32 ob.gyn. residents and 12 fellows who were already in the program, she said.
To ease residents’ integration into an away program, the Ryan Program – along with the American College of Obstetricians and Gynecologists, the Council on Resident Education in Obstetrics and Gynecology, and Innovating Education in Reproductive Health – recently began offering a free, web-based patient-centered abortion education curriculum.
The course supplements in-person clinical training in abortion care and prepares residents traveling and transitioning into another program to begin learning new skills on their first day, AnnaMarie Connolly, MD, ACOG’s chief of education and academic affairs, said in a prepared statement.
Training costs
Residents and their institutions also face additional costs. The home institution that loses a resident for a few weeks to a month has to determine how to cover the care not provided while they are away, Ms. Simonson said. Residents may incur expenses for transportation, housing, food, and other things while out of state.
OHSU covers transportation and housing through its abortion care and training fund, but there are other factors to consider, Dr. Colwill said. For example, the home and host programs have to coordinate licensing, malpractice, and line up rotation dates, she said.
Among other complications, UNM wasn’t able to set up an agreement so that its new resident could participate in a rotation at Planned Parenthood. “We have the clinical volume to accommodate another learner,” Dr. Forbis said. But the program has to balance resources, such as “trying to make sure we don’t have one faculty [member] assigned to too many learners at one time,” she said.
Given the logistic and financial challenges, programs may not be able to ensure that all residents who need abortion training receive it, said Ms. Simonson.
The Ryan Program, for instance, can’t help the more than 100 residency programs in states where abortions are currently illegal, she said.
UNM is trying to partner with specific programs, such as those in the state of Texas where abortion is banned, to train its residents each year, Dr. Forbis said.
OHSU also will look for opportunities to train as many residents as possible, Dr. Colwill said, “but I don’t think we’ll ever be able to fill that gap of 1,000 residents that need this training.”
A version of this article first appeared on Medscape.com.
to fulfill required clinical rotations in the procedure.
The Accreditation Council for Graduate Medical Education requires ob.gyn. residents – unless they have a religious or moral exemption – to undergo abortion training to complete their programs. In states with bans or restrictions on family planning services or abortions, resident training must be received at institutions that are out of state.
Some residency programs are just beginning to coordinate out-of-state training, while others are further along in their offerings. There’s no formal matching process, and it remains unclear who will cover the costs of residents training elsewhere for a month.
These uncertainties, along with lack of coordination about malpractice, clinical rotations, and limited faculty, leave some program directors skeptical they’ll be able to keep up with demand for out-of-state slots. They are also wary of harming their own residents’ educational and clinical opportunities.
A 3rd-year ob.gyn. resident, who didn’t want to give her name or residency program for fear of backlash against her home institution, told this news organization that the Catholic-affiliated site is trying to avoid drawing attention to its minimal abortion training in a restrictive Midwest state. She knew after the Supreme Court’s decision in Dobbs v. Jackson she’d have to look outside the program for more complex abortion training.
While she could learn dilation and curettage or other first-trimester or early–second-trimester procedures at the Midwest program, she said she couldn’t learn dilation and evacuation.
A mentor at her program connected her with a residency program at the University of New Mexico, where she recently started a 5-week family planning rotation. She is the first out-of-state resident hosted by UNM. Currently, UNM has six ob.gyn. residents per class year, for a total of 36, and six family planning fellows.
The ob.gyn. resident is staying with a friend at no cost, and her home institution still pays her salary. But she still must pay the mortgage on a home she can’t live in while away and misses being part of a community where she’s built a life over the past 2 years.
“There’s a part of you that’s just angry that you can’t do this for the women ... in your state,” she said. “Unfortunately, there isn’t a formalized program for ob.gyn. residents interested in more advanced training to be matched with a program that has the ability to offer that training. It’s very much a word-of-mouth and who-you-know situation. For people without those connections, it can be difficult to obtain this training unless they are interested in a formal fellowship.”
This year, about 1,500 ob.gyn. residents matched into 280 residency programs, according to the National Residency Matching Program.
Alyssa Colwill, MD, assistant professor of obstetrics and gynecology at Oregon Health and Science University and director of the ob.gyn. Ryan Residency Program at OHSU, estimated that 1,000 ob.gyn. residents per year will seek out-of-state abortion training. The estimate is based on the number of residents in programs in states with restrictions.
The Ryan Program, which began in 1999, helps ob.gyn. residency programs provide training in abortion and contraception care (family planning) as a required rotation.
Connecting programs
Ryan-affiliated residencies have been helping connect programs in states with abortion bans and restrictions to programs in states with more liberal laws.
Twelve of the 100 Ryan programs sent residents out of state in the past academic year, and 15 will follow this year. More are expected soon, said Kristin Simonson, MA, director of programs and operations at the Ryan Residency Program, headquartered at the Bixby Center for Global Reproductive Health at the University of California, San Francisco.
Before the Dobbs decision, very few programs considered next steps to train ob.gyn. residents if abortions became illegal, Ms. Simonson said. “I think a lot of people just kind of were waiting and seeing ... and hoping that they wouldn’t have to make any drastic plans. It was hard to motivate people to have a plan B ready to go,” she said.
“Almost all of us working in this field had a really bad feeling,” said Courtney G. Forbis, MD, UNM assistant professor of ob.gyn. and Ryan Residency director. She and colleagues began planning for the future months ahead of the court decision. But the program wasn’t able to begin accepting out-of-state residents until now, she said. “We are trying to use this experience to see what we can accommodate in the future.”
OHSU also began planning for alternative training when it learned of the leaked Supreme Court decision, Dr. Colwill said. “We decided that we had the bandwidth and opportunity to train more individuals that were going to lose access to services and educational opportunities,” she said.
The university ran a 4-week test rotation last fall. So far, six residents and one fellow have come from out of the state, said Dr. Colwill. OHSU hopes to have 10 more in the coming year. The out-of-state learners will join 32 ob.gyn. residents and 12 fellows who were already in the program, she said.
To ease residents’ integration into an away program, the Ryan Program – along with the American College of Obstetricians and Gynecologists, the Council on Resident Education in Obstetrics and Gynecology, and Innovating Education in Reproductive Health – recently began offering a free, web-based patient-centered abortion education curriculum.
The course supplements in-person clinical training in abortion care and prepares residents traveling and transitioning into another program to begin learning new skills on their first day, AnnaMarie Connolly, MD, ACOG’s chief of education and academic affairs, said in a prepared statement.
Training costs
Residents and their institutions also face additional costs. The home institution that loses a resident for a few weeks to a month has to determine how to cover the care not provided while they are away, Ms. Simonson said. Residents may incur expenses for transportation, housing, food, and other things while out of state.
OHSU covers transportation and housing through its abortion care and training fund, but there are other factors to consider, Dr. Colwill said. For example, the home and host programs have to coordinate licensing, malpractice, and line up rotation dates, she said.
Among other complications, UNM wasn’t able to set up an agreement so that its new resident could participate in a rotation at Planned Parenthood. “We have the clinical volume to accommodate another learner,” Dr. Forbis said. But the program has to balance resources, such as “trying to make sure we don’t have one faculty [member] assigned to too many learners at one time,” she said.
Given the logistic and financial challenges, programs may not be able to ensure that all residents who need abortion training receive it, said Ms. Simonson.
The Ryan Program, for instance, can’t help the more than 100 residency programs in states where abortions are currently illegal, she said.
UNM is trying to partner with specific programs, such as those in the state of Texas where abortion is banned, to train its residents each year, Dr. Forbis said.
OHSU also will look for opportunities to train as many residents as possible, Dr. Colwill said, “but I don’t think we’ll ever be able to fill that gap of 1,000 residents that need this training.”
A version of this article first appeared on Medscape.com.
to fulfill required clinical rotations in the procedure.
The Accreditation Council for Graduate Medical Education requires ob.gyn. residents – unless they have a religious or moral exemption – to undergo abortion training to complete their programs. In states with bans or restrictions on family planning services or abortions, resident training must be received at institutions that are out of state.
Some residency programs are just beginning to coordinate out-of-state training, while others are further along in their offerings. There’s no formal matching process, and it remains unclear who will cover the costs of residents training elsewhere for a month.
These uncertainties, along with lack of coordination about malpractice, clinical rotations, and limited faculty, leave some program directors skeptical they’ll be able to keep up with demand for out-of-state slots. They are also wary of harming their own residents’ educational and clinical opportunities.
A 3rd-year ob.gyn. resident, who didn’t want to give her name or residency program for fear of backlash against her home institution, told this news organization that the Catholic-affiliated site is trying to avoid drawing attention to its minimal abortion training in a restrictive Midwest state. She knew after the Supreme Court’s decision in Dobbs v. Jackson she’d have to look outside the program for more complex abortion training.
While she could learn dilation and curettage or other first-trimester or early–second-trimester procedures at the Midwest program, she said she couldn’t learn dilation and evacuation.
A mentor at her program connected her with a residency program at the University of New Mexico, where she recently started a 5-week family planning rotation. She is the first out-of-state resident hosted by UNM. Currently, UNM has six ob.gyn. residents per class year, for a total of 36, and six family planning fellows.
The ob.gyn. resident is staying with a friend at no cost, and her home institution still pays her salary. But she still must pay the mortgage on a home she can’t live in while away and misses being part of a community where she’s built a life over the past 2 years.
“There’s a part of you that’s just angry that you can’t do this for the women ... in your state,” she said. “Unfortunately, there isn’t a formalized program for ob.gyn. residents interested in more advanced training to be matched with a program that has the ability to offer that training. It’s very much a word-of-mouth and who-you-know situation. For people without those connections, it can be difficult to obtain this training unless they are interested in a formal fellowship.”
This year, about 1,500 ob.gyn. residents matched into 280 residency programs, according to the National Residency Matching Program.
Alyssa Colwill, MD, assistant professor of obstetrics and gynecology at Oregon Health and Science University and director of the ob.gyn. Ryan Residency Program at OHSU, estimated that 1,000 ob.gyn. residents per year will seek out-of-state abortion training. The estimate is based on the number of residents in programs in states with restrictions.
The Ryan Program, which began in 1999, helps ob.gyn. residency programs provide training in abortion and contraception care (family planning) as a required rotation.
Connecting programs
Ryan-affiliated residencies have been helping connect programs in states with abortion bans and restrictions to programs in states with more liberal laws.
Twelve of the 100 Ryan programs sent residents out of state in the past academic year, and 15 will follow this year. More are expected soon, said Kristin Simonson, MA, director of programs and operations at the Ryan Residency Program, headquartered at the Bixby Center for Global Reproductive Health at the University of California, San Francisco.
Before the Dobbs decision, very few programs considered next steps to train ob.gyn. residents if abortions became illegal, Ms. Simonson said. “I think a lot of people just kind of were waiting and seeing ... and hoping that they wouldn’t have to make any drastic plans. It was hard to motivate people to have a plan B ready to go,” she said.
“Almost all of us working in this field had a really bad feeling,” said Courtney G. Forbis, MD, UNM assistant professor of ob.gyn. and Ryan Residency director. She and colleagues began planning for the future months ahead of the court decision. But the program wasn’t able to begin accepting out-of-state residents until now, she said. “We are trying to use this experience to see what we can accommodate in the future.”
OHSU also began planning for alternative training when it learned of the leaked Supreme Court decision, Dr. Colwill said. “We decided that we had the bandwidth and opportunity to train more individuals that were going to lose access to services and educational opportunities,” she said.
The university ran a 4-week test rotation last fall. So far, six residents and one fellow have come from out of the state, said Dr. Colwill. OHSU hopes to have 10 more in the coming year. The out-of-state learners will join 32 ob.gyn. residents and 12 fellows who were already in the program, she said.
To ease residents’ integration into an away program, the Ryan Program – along with the American College of Obstetricians and Gynecologists, the Council on Resident Education in Obstetrics and Gynecology, and Innovating Education in Reproductive Health – recently began offering a free, web-based patient-centered abortion education curriculum.
The course supplements in-person clinical training in abortion care and prepares residents traveling and transitioning into another program to begin learning new skills on their first day, AnnaMarie Connolly, MD, ACOG’s chief of education and academic affairs, said in a prepared statement.
Training costs
Residents and their institutions also face additional costs. The home institution that loses a resident for a few weeks to a month has to determine how to cover the care not provided while they are away, Ms. Simonson said. Residents may incur expenses for transportation, housing, food, and other things while out of state.
OHSU covers transportation and housing through its abortion care and training fund, but there are other factors to consider, Dr. Colwill said. For example, the home and host programs have to coordinate licensing, malpractice, and line up rotation dates, she said.
Among other complications, UNM wasn’t able to set up an agreement so that its new resident could participate in a rotation at Planned Parenthood. “We have the clinical volume to accommodate another learner,” Dr. Forbis said. But the program has to balance resources, such as “trying to make sure we don’t have one faculty [member] assigned to too many learners at one time,” she said.
Given the logistic and financial challenges, programs may not be able to ensure that all residents who need abortion training receive it, said Ms. Simonson.
The Ryan Program, for instance, can’t help the more than 100 residency programs in states where abortions are currently illegal, she said.
UNM is trying to partner with specific programs, such as those in the state of Texas where abortion is banned, to train its residents each year, Dr. Forbis said.
OHSU also will look for opportunities to train as many residents as possible, Dr. Colwill said, “but I don’t think we’ll ever be able to fill that gap of 1,000 residents that need this training.”
A version of this article first appeared on Medscape.com.
Use of mental health services soared during pandemic
By the end of August 2022, overall use of mental health services was almost 40% higher than before the COVID-19 pandemic, while spending increased by 54%, according to a new study by researchers at the RAND Corporation.
During the early phase of the pandemic, from mid-March to mid-December 2020, before the vaccine was available, in-person visits decreased by 40%, while telehealth visits increased by 1,000%, reported Jonathan H. Cantor, PhD, and colleagues at RAND, and at Castlight Health, a benefit coordination provider, in a paper published online in JAMA Health Forum.
Between December 2020 and August 2022, telehealth visits stayed stable, but in-person visits creeped back up, eventually reaching 80% of prepandemic levels. However, “total utilization was higher than before the pandemic,” Dr. Cantor, a policy researcher at RAND, told this news organization.
“It could be that it’s easier for individuals to receive care via telehealth, but it could also just be that there’s a greater demand or need since the pandemic,” said Dr. Cantor. “We’ll just need more research to actually unpack what’s going on,” he said.
Initial per capita spending increased by about a third and was up overall by more than half. But it’s not clear how much of that is due to utilization or to price of services, said Dr. Cantor. Spending for telehealth services remained stable in the post-vaccine period, while spending on in-person visits returned to prepandemic levels.
Dr. Cantor and his colleagues were not able to determine whether utilization was by new or existing patients, but he said that would be good data to have. “It would be really important to know whether or not folks are initiating care because telehealth is making it easier,” he said.
The authors analyzed about 1.5 million claims for anxiety disorders, major depressive disorder, bipolar disorder, schizophrenia, and posttraumatic stress disorder, out of claims submitted by 7 million commercially insured adults whose self-insured employers used the Castlight benefit.
Dr. Cantor noted that this is just a small subset of the U.S. population. He said he’d like to have data from Medicare and Medicaid to fully assess the impact of the COVID-19 pandemic on mental health and of telehealth visits.
“This is a still-burgeoning field,” he said about telehealth. “We’re still trying to get a handle on how things are operating, given that there’s been so much change so rapidly.”
Meanwhile, 152 major employers responding to a large national survey this summer said that they’ve been grappling with how COVID-19 has affected workers. The employers include 72 Fortune 100 companies and provide health coverage for more than 60 million workers, retirees, and their families.
Seventy-seven percent said they are currently seeing an increase in depression, anxiety, and substance use disorders as a result of the pandemic, according to the Business Group on Health’s survey. That’s up from 44% in 2022.
Going forward, employers will focus on increasing access to mental health services, the survey reported.
“Our survey found that in 2024 and for the near future, employers will be acutely focused on addressing employees’ mental health needs while ensuring access and lowering cost barriers,” Ellen Kelsay, president and CEO of Business Group on Health, said in a statement.
The study was supported by grants from the National Institute of Mental Health and the National Institute on Aging. Coauthor Dena Bravata, MD, a Castlight employee, reported receiving personal fees from Castlight Health during the conduct of the study. Coauthor Christopher M. Whaley, a RAND employee, reported receiving personal fees from Castlight Health outside the submitted work.
A version of this article appeared on Medscape.com.
By the end of August 2022, overall use of mental health services was almost 40% higher than before the COVID-19 pandemic, while spending increased by 54%, according to a new study by researchers at the RAND Corporation.
During the early phase of the pandemic, from mid-March to mid-December 2020, before the vaccine was available, in-person visits decreased by 40%, while telehealth visits increased by 1,000%, reported Jonathan H. Cantor, PhD, and colleagues at RAND, and at Castlight Health, a benefit coordination provider, in a paper published online in JAMA Health Forum.
Between December 2020 and August 2022, telehealth visits stayed stable, but in-person visits creeped back up, eventually reaching 80% of prepandemic levels. However, “total utilization was higher than before the pandemic,” Dr. Cantor, a policy researcher at RAND, told this news organization.
“It could be that it’s easier for individuals to receive care via telehealth, but it could also just be that there’s a greater demand or need since the pandemic,” said Dr. Cantor. “We’ll just need more research to actually unpack what’s going on,” he said.
Initial per capita spending increased by about a third and was up overall by more than half. But it’s not clear how much of that is due to utilization or to price of services, said Dr. Cantor. Spending for telehealth services remained stable in the post-vaccine period, while spending on in-person visits returned to prepandemic levels.
Dr. Cantor and his colleagues were not able to determine whether utilization was by new or existing patients, but he said that would be good data to have. “It would be really important to know whether or not folks are initiating care because telehealth is making it easier,” he said.
The authors analyzed about 1.5 million claims for anxiety disorders, major depressive disorder, bipolar disorder, schizophrenia, and posttraumatic stress disorder, out of claims submitted by 7 million commercially insured adults whose self-insured employers used the Castlight benefit.
Dr. Cantor noted that this is just a small subset of the U.S. population. He said he’d like to have data from Medicare and Medicaid to fully assess the impact of the COVID-19 pandemic on mental health and of telehealth visits.
“This is a still-burgeoning field,” he said about telehealth. “We’re still trying to get a handle on how things are operating, given that there’s been so much change so rapidly.”
Meanwhile, 152 major employers responding to a large national survey this summer said that they’ve been grappling with how COVID-19 has affected workers. The employers include 72 Fortune 100 companies and provide health coverage for more than 60 million workers, retirees, and their families.
Seventy-seven percent said they are currently seeing an increase in depression, anxiety, and substance use disorders as a result of the pandemic, according to the Business Group on Health’s survey. That’s up from 44% in 2022.
Going forward, employers will focus on increasing access to mental health services, the survey reported.
“Our survey found that in 2024 and for the near future, employers will be acutely focused on addressing employees’ mental health needs while ensuring access and lowering cost barriers,” Ellen Kelsay, president and CEO of Business Group on Health, said in a statement.
The study was supported by grants from the National Institute of Mental Health and the National Institute on Aging. Coauthor Dena Bravata, MD, a Castlight employee, reported receiving personal fees from Castlight Health during the conduct of the study. Coauthor Christopher M. Whaley, a RAND employee, reported receiving personal fees from Castlight Health outside the submitted work.
A version of this article appeared on Medscape.com.
By the end of August 2022, overall use of mental health services was almost 40% higher than before the COVID-19 pandemic, while spending increased by 54%, according to a new study by researchers at the RAND Corporation.
During the early phase of the pandemic, from mid-March to mid-December 2020, before the vaccine was available, in-person visits decreased by 40%, while telehealth visits increased by 1,000%, reported Jonathan H. Cantor, PhD, and colleagues at RAND, and at Castlight Health, a benefit coordination provider, in a paper published online in JAMA Health Forum.
Between December 2020 and August 2022, telehealth visits stayed stable, but in-person visits creeped back up, eventually reaching 80% of prepandemic levels. However, “total utilization was higher than before the pandemic,” Dr. Cantor, a policy researcher at RAND, told this news organization.
“It could be that it’s easier for individuals to receive care via telehealth, but it could also just be that there’s a greater demand or need since the pandemic,” said Dr. Cantor. “We’ll just need more research to actually unpack what’s going on,” he said.
Initial per capita spending increased by about a third and was up overall by more than half. But it’s not clear how much of that is due to utilization or to price of services, said Dr. Cantor. Spending for telehealth services remained stable in the post-vaccine period, while spending on in-person visits returned to prepandemic levels.
Dr. Cantor and his colleagues were not able to determine whether utilization was by new or existing patients, but he said that would be good data to have. “It would be really important to know whether or not folks are initiating care because telehealth is making it easier,” he said.
The authors analyzed about 1.5 million claims for anxiety disorders, major depressive disorder, bipolar disorder, schizophrenia, and posttraumatic stress disorder, out of claims submitted by 7 million commercially insured adults whose self-insured employers used the Castlight benefit.
Dr. Cantor noted that this is just a small subset of the U.S. population. He said he’d like to have data from Medicare and Medicaid to fully assess the impact of the COVID-19 pandemic on mental health and of telehealth visits.
“This is a still-burgeoning field,” he said about telehealth. “We’re still trying to get a handle on how things are operating, given that there’s been so much change so rapidly.”
Meanwhile, 152 major employers responding to a large national survey this summer said that they’ve been grappling with how COVID-19 has affected workers. The employers include 72 Fortune 100 companies and provide health coverage for more than 60 million workers, retirees, and their families.
Seventy-seven percent said they are currently seeing an increase in depression, anxiety, and substance use disorders as a result of the pandemic, according to the Business Group on Health’s survey. That’s up from 44% in 2022.
Going forward, employers will focus on increasing access to mental health services, the survey reported.
“Our survey found that in 2024 and for the near future, employers will be acutely focused on addressing employees’ mental health needs while ensuring access and lowering cost barriers,” Ellen Kelsay, president and CEO of Business Group on Health, said in a statement.
The study was supported by grants from the National Institute of Mental Health and the National Institute on Aging. Coauthor Dena Bravata, MD, a Castlight employee, reported receiving personal fees from Castlight Health during the conduct of the study. Coauthor Christopher M. Whaley, a RAND employee, reported receiving personal fees from Castlight Health outside the submitted work.
A version of this article appeared on Medscape.com.
Marijuana, hallucinogen use, binge drinking at all-time high
The latest results of the Monitoring the Future (MTF) longitudinal survey show that American adults are consuming marijuana and hallucinogens, vaping, and binge drinking at historic levels.
“In 2022, we are seeing that marijuana and hallucinogen use, and vaping of nicotine and marijuana, are higher than ever among young adults ages 19-30,” said Megan Patrick, research professor and principal investigator of the MTF study. “In addition, midlife adults ages 35-50 have the highest level of binge drinking we have ever seen in that age group,” she said in a statement.
The survey, conducted annually since 1975 by the University of Michigan’s Institute for Social Research, Ann Arbor, queries nationally representative samples of 8th, 10th, and 12th graders and then follows a subset through adulthood to come up with longitudinal data. It is funded by the National Institute on Drug Abuse.
The adult data for 2022 were gathered by online and paper surveys from April to October 2022 and included responses from some 10,000 individuals. Participants were divided into two cohorts: those aged 19-30 years and those aged 35-50 years.
About a third of the older age group reported using marijuana in the past year, an all-time high, up from 25% in 2021 and more than double the users in 2012 (13%). Of this group, 4% reported past-year hallucinogen use, also a record high and double the reported use in 2021.
Alcohol use among adults aged 35-50 has gradually increased over the past decade. Of this group, 85% reported past-year drinking in 2022, up from 83% in 2012.
Binge drinking – defined as having five or more drinks in a row in the past 2 weeks – has also been on the rise in the past decade. One-third of older adults reported binge drinking in 2022. Binge drinking was highest among White (31.4%) and Hispanic (30.6%) midlife adults and was lower among Black (17.1%) midlife adults.
Vaping among the older age cohort has remained at similar levels since first measured in 2019; 9% vaped marijuana in the past year, while 7% vaped nicotine.
Marijuana popular among younger Americans
“In 2022, marijuana use among young adults reached the highest levels ever recorded since the indices were first available in 1988,” the study authors write. Both past-year and daily use hit record levels for the cohort of those aged 19-30.
Forty-four percent reported past-year marijuana use, up from 28% in 2012. The highest levels of use were in those aged 27-28. One in five reported daily use, up from 6% a decade ago; almost 14% of 23- to 24-year-olds reported daily use.
Past-year use of hallucinogens – including LSD, MDMA, mescaline, peyote, mushrooms or psilocybin, and PCP – was reported by 8% of this age group. Most of the increase was driven by use of hallucinogens other than LSD, which accounted for 7% of the reported use.
Young adults also reported record levels of vaping marijuana, with 21% reporting past-year use and 14% reporting past-month use. Vaping of nicotine has doubled in prevalence since the survey started asking about it, from 14% for past-year use in 2017 to 24% in 2022.
NIDA Director Nora Volkow, MD, noted in a statement that the survey results show that “substance use is not limited to teens and young adults,” adding that “these data help us understand how people use drugs across the lifespan.”
A version of this article first appeared on Medscape.com.
The latest results of the Monitoring the Future (MTF) longitudinal survey show that American adults are consuming marijuana and hallucinogens, vaping, and binge drinking at historic levels.
“In 2022, we are seeing that marijuana and hallucinogen use, and vaping of nicotine and marijuana, are higher than ever among young adults ages 19-30,” said Megan Patrick, research professor and principal investigator of the MTF study. “In addition, midlife adults ages 35-50 have the highest level of binge drinking we have ever seen in that age group,” she said in a statement.
The survey, conducted annually since 1975 by the University of Michigan’s Institute for Social Research, Ann Arbor, queries nationally representative samples of 8th, 10th, and 12th graders and then follows a subset through adulthood to come up with longitudinal data. It is funded by the National Institute on Drug Abuse.
The adult data for 2022 were gathered by online and paper surveys from April to October 2022 and included responses from some 10,000 individuals. Participants were divided into two cohorts: those aged 19-30 years and those aged 35-50 years.
About a third of the older age group reported using marijuana in the past year, an all-time high, up from 25% in 2021 and more than double the users in 2012 (13%). Of this group, 4% reported past-year hallucinogen use, also a record high and double the reported use in 2021.
Alcohol use among adults aged 35-50 has gradually increased over the past decade. Of this group, 85% reported past-year drinking in 2022, up from 83% in 2012.
Binge drinking – defined as having five or more drinks in a row in the past 2 weeks – has also been on the rise in the past decade. One-third of older adults reported binge drinking in 2022. Binge drinking was highest among White (31.4%) and Hispanic (30.6%) midlife adults and was lower among Black (17.1%) midlife adults.
Vaping among the older age cohort has remained at similar levels since first measured in 2019; 9% vaped marijuana in the past year, while 7% vaped nicotine.
Marijuana popular among younger Americans
“In 2022, marijuana use among young adults reached the highest levels ever recorded since the indices were first available in 1988,” the study authors write. Both past-year and daily use hit record levels for the cohort of those aged 19-30.
Forty-four percent reported past-year marijuana use, up from 28% in 2012. The highest levels of use were in those aged 27-28. One in five reported daily use, up from 6% a decade ago; almost 14% of 23- to 24-year-olds reported daily use.
Past-year use of hallucinogens – including LSD, MDMA, mescaline, peyote, mushrooms or psilocybin, and PCP – was reported by 8% of this age group. Most of the increase was driven by use of hallucinogens other than LSD, which accounted for 7% of the reported use.
Young adults also reported record levels of vaping marijuana, with 21% reporting past-year use and 14% reporting past-month use. Vaping of nicotine has doubled in prevalence since the survey started asking about it, from 14% for past-year use in 2017 to 24% in 2022.
NIDA Director Nora Volkow, MD, noted in a statement that the survey results show that “substance use is not limited to teens and young adults,” adding that “these data help us understand how people use drugs across the lifespan.”
A version of this article first appeared on Medscape.com.
The latest results of the Monitoring the Future (MTF) longitudinal survey show that American adults are consuming marijuana and hallucinogens, vaping, and binge drinking at historic levels.
“In 2022, we are seeing that marijuana and hallucinogen use, and vaping of nicotine and marijuana, are higher than ever among young adults ages 19-30,” said Megan Patrick, research professor and principal investigator of the MTF study. “In addition, midlife adults ages 35-50 have the highest level of binge drinking we have ever seen in that age group,” she said in a statement.
The survey, conducted annually since 1975 by the University of Michigan’s Institute for Social Research, Ann Arbor, queries nationally representative samples of 8th, 10th, and 12th graders and then follows a subset through adulthood to come up with longitudinal data. It is funded by the National Institute on Drug Abuse.
The adult data for 2022 were gathered by online and paper surveys from April to October 2022 and included responses from some 10,000 individuals. Participants were divided into two cohorts: those aged 19-30 years and those aged 35-50 years.
About a third of the older age group reported using marijuana in the past year, an all-time high, up from 25% in 2021 and more than double the users in 2012 (13%). Of this group, 4% reported past-year hallucinogen use, also a record high and double the reported use in 2021.
Alcohol use among adults aged 35-50 has gradually increased over the past decade. Of this group, 85% reported past-year drinking in 2022, up from 83% in 2012.
Binge drinking – defined as having five or more drinks in a row in the past 2 weeks – has also been on the rise in the past decade. One-third of older adults reported binge drinking in 2022. Binge drinking was highest among White (31.4%) and Hispanic (30.6%) midlife adults and was lower among Black (17.1%) midlife adults.
Vaping among the older age cohort has remained at similar levels since first measured in 2019; 9% vaped marijuana in the past year, while 7% vaped nicotine.
Marijuana popular among younger Americans
“In 2022, marijuana use among young adults reached the highest levels ever recorded since the indices were first available in 1988,” the study authors write. Both past-year and daily use hit record levels for the cohort of those aged 19-30.
Forty-four percent reported past-year marijuana use, up from 28% in 2012. The highest levels of use were in those aged 27-28. One in five reported daily use, up from 6% a decade ago; almost 14% of 23- to 24-year-olds reported daily use.
Past-year use of hallucinogens – including LSD, MDMA, mescaline, peyote, mushrooms or psilocybin, and PCP – was reported by 8% of this age group. Most of the increase was driven by use of hallucinogens other than LSD, which accounted for 7% of the reported use.
Young adults also reported record levels of vaping marijuana, with 21% reporting past-year use and 14% reporting past-month use. Vaping of nicotine has doubled in prevalence since the survey started asking about it, from 14% for past-year use in 2017 to 24% in 2022.
NIDA Director Nora Volkow, MD, noted in a statement that the survey results show that “substance use is not limited to teens and young adults,” adding that “these data help us understand how people use drugs across the lifespan.”
A version of this article first appeared on Medscape.com.
Medicare to pay for at-home dementia care coordination
Under a new Medicare pilot program that will begin in 2024, the federal government will pay clinicians to coordinate at-home dementia support services, including respite care for family members.
A Department of Health & Human Services initiative, part of the aim of the Guiding an Improved Dementia Experience (GUIDE) program is to help Medicare beneficiaries with dementia stay in the community for as long as possible. It is estimated that there are 6.7 million Americans living with Alzheimer’s disease or some other form of dementia, said HHS.
The program is voluntary and will be open to Medicare-enrolled clinicians and other providers who can assemble an interdisciplinary care team and meet the program’s participation criteria.
“Our new GUIDE Model has the potential to improve the quality of life for people with dementia and alleviate the significant strain on our families,” said HHS Secretary Xavier Becerra, in a statement.
“Not only is dementia care management a proven way to improve the quality of care and quality of life for those living with Alzheimer’s and other dementia, but now we know that it would also save the federal government billions of dollars,” Robert Egge, Alzheimer’s Association chief public policy officer and Alzheimer’s Impact Movement (AIM) executive director, said in a statement.
Mr. Egge cited a recent analysis commissioned by AIM that found that dementia care management would save the federal government nearly $21 billion over 10 years.
“People living with dementia and their caregivers too often struggle to manage their health care and connect with key supports that can allow them to remain in their homes and communities,” said Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure, in the HHS statement.
“Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden,” she said, adding that Black, Hispanic, Asian American, Native Hawaiian, and Pacific Islander populations have been especially disadvantaged.
The GUIDE Model will provide new resources and greater access to specialty care to those communities, said Ms. Brooks-LaSure.
Care teams that seek to participate in the GUIDE model must have a care navigator who has received required training in dementia, assessment, and care planning.
The teams also must have a clinician with dementia proficiency as recognized by experience caring for adults with cognitive impairment; experience caring for patients aged 65 years old or older; or specialty designation in neurology, psychiatry, geriatrics, geriatric psychiatry, behavioral neurology, or geriatric neurology.
Medicare beneficiaries will be eligible if they are not residing in a nursing home; are not enrolled in hospice; and have a confirmed dementia diagnosis.
Beneficiaries who receive care from GUIDE participants will be placed in one of five “tiers,” based on a combination of disease stage and caregiver status. Beneficiary needs, and care intensity and payment, increase by tier.
GUIDE teams will receive a monthly, per-beneficiary amount for providing care management and coordination and caregiver education and support services. They can also bill for respite services – up to an annual cap – for Medicare beneficiaries who have an unpaid caregiver.
Clinicians seeking to participate in GUIDE can apply beginning in the fall. The program will run for 8 years beginning July 1, 2024.
Alzheimer’s Association President and CEO Joanne Pike, DrPH, said in a statement that the organization had “advocated for this approach for years, believing it [to be] the key to addressing systemic challenges faced by those with dementia, their families and those who provide them with care and support.”
The John A. Hartford Foundation noted that it also had long pushed for a comprehensive dementia care program. “Comprehensive dementia care supports both the medical and nonmedical needs of patients and their family caregivers,” said Foundation President Terry Fulmer, PhD, RN, FAAN, in a statement.
“Notably and necessarily, the model will help improve equity in access to care for underserved communities by addressing unpaid caregiver needs, including respite services and screening for health-related social needs,” added Dr. Fulmer.
A version of this article first appeared on Medscape.com.
Under a new Medicare pilot program that will begin in 2024, the federal government will pay clinicians to coordinate at-home dementia support services, including respite care for family members.
A Department of Health & Human Services initiative, part of the aim of the Guiding an Improved Dementia Experience (GUIDE) program is to help Medicare beneficiaries with dementia stay in the community for as long as possible. It is estimated that there are 6.7 million Americans living with Alzheimer’s disease or some other form of dementia, said HHS.
The program is voluntary and will be open to Medicare-enrolled clinicians and other providers who can assemble an interdisciplinary care team and meet the program’s participation criteria.
“Our new GUIDE Model has the potential to improve the quality of life for people with dementia and alleviate the significant strain on our families,” said HHS Secretary Xavier Becerra, in a statement.
“Not only is dementia care management a proven way to improve the quality of care and quality of life for those living with Alzheimer’s and other dementia, but now we know that it would also save the federal government billions of dollars,” Robert Egge, Alzheimer’s Association chief public policy officer and Alzheimer’s Impact Movement (AIM) executive director, said in a statement.
Mr. Egge cited a recent analysis commissioned by AIM that found that dementia care management would save the federal government nearly $21 billion over 10 years.
“People living with dementia and their caregivers too often struggle to manage their health care and connect with key supports that can allow them to remain in their homes and communities,” said Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure, in the HHS statement.
“Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden,” she said, adding that Black, Hispanic, Asian American, Native Hawaiian, and Pacific Islander populations have been especially disadvantaged.
The GUIDE Model will provide new resources and greater access to specialty care to those communities, said Ms. Brooks-LaSure.
Care teams that seek to participate in the GUIDE model must have a care navigator who has received required training in dementia, assessment, and care planning.
The teams also must have a clinician with dementia proficiency as recognized by experience caring for adults with cognitive impairment; experience caring for patients aged 65 years old or older; or specialty designation in neurology, psychiatry, geriatrics, geriatric psychiatry, behavioral neurology, or geriatric neurology.
Medicare beneficiaries will be eligible if they are not residing in a nursing home; are not enrolled in hospice; and have a confirmed dementia diagnosis.
Beneficiaries who receive care from GUIDE participants will be placed in one of five “tiers,” based on a combination of disease stage and caregiver status. Beneficiary needs, and care intensity and payment, increase by tier.
GUIDE teams will receive a monthly, per-beneficiary amount for providing care management and coordination and caregiver education and support services. They can also bill for respite services – up to an annual cap – for Medicare beneficiaries who have an unpaid caregiver.
Clinicians seeking to participate in GUIDE can apply beginning in the fall. The program will run for 8 years beginning July 1, 2024.
Alzheimer’s Association President and CEO Joanne Pike, DrPH, said in a statement that the organization had “advocated for this approach for years, believing it [to be] the key to addressing systemic challenges faced by those with dementia, their families and those who provide them with care and support.”
The John A. Hartford Foundation noted that it also had long pushed for a comprehensive dementia care program. “Comprehensive dementia care supports both the medical and nonmedical needs of patients and their family caregivers,” said Foundation President Terry Fulmer, PhD, RN, FAAN, in a statement.
“Notably and necessarily, the model will help improve equity in access to care for underserved communities by addressing unpaid caregiver needs, including respite services and screening for health-related social needs,” added Dr. Fulmer.
A version of this article first appeared on Medscape.com.
Under a new Medicare pilot program that will begin in 2024, the federal government will pay clinicians to coordinate at-home dementia support services, including respite care for family members.
A Department of Health & Human Services initiative, part of the aim of the Guiding an Improved Dementia Experience (GUIDE) program is to help Medicare beneficiaries with dementia stay in the community for as long as possible. It is estimated that there are 6.7 million Americans living with Alzheimer’s disease or some other form of dementia, said HHS.
The program is voluntary and will be open to Medicare-enrolled clinicians and other providers who can assemble an interdisciplinary care team and meet the program’s participation criteria.
“Our new GUIDE Model has the potential to improve the quality of life for people with dementia and alleviate the significant strain on our families,” said HHS Secretary Xavier Becerra, in a statement.
“Not only is dementia care management a proven way to improve the quality of care and quality of life for those living with Alzheimer’s and other dementia, but now we know that it would also save the federal government billions of dollars,” Robert Egge, Alzheimer’s Association chief public policy officer and Alzheimer’s Impact Movement (AIM) executive director, said in a statement.
Mr. Egge cited a recent analysis commissioned by AIM that found that dementia care management would save the federal government nearly $21 billion over 10 years.
“People living with dementia and their caregivers too often struggle to manage their health care and connect with key supports that can allow them to remain in their homes and communities,” said Centers for Medicare & Medicaid Services Administrator Chiquita Brooks-LaSure, in the HHS statement.
“Fragmented care contributes to the mental and physical health strain of caring for someone with dementia, as well as the substantial financial burden,” she said, adding that Black, Hispanic, Asian American, Native Hawaiian, and Pacific Islander populations have been especially disadvantaged.
The GUIDE Model will provide new resources and greater access to specialty care to those communities, said Ms. Brooks-LaSure.
Care teams that seek to participate in the GUIDE model must have a care navigator who has received required training in dementia, assessment, and care planning.
The teams also must have a clinician with dementia proficiency as recognized by experience caring for adults with cognitive impairment; experience caring for patients aged 65 years old or older; or specialty designation in neurology, psychiatry, geriatrics, geriatric psychiatry, behavioral neurology, or geriatric neurology.
Medicare beneficiaries will be eligible if they are not residing in a nursing home; are not enrolled in hospice; and have a confirmed dementia diagnosis.
Beneficiaries who receive care from GUIDE participants will be placed in one of five “tiers,” based on a combination of disease stage and caregiver status. Beneficiary needs, and care intensity and payment, increase by tier.
GUIDE teams will receive a monthly, per-beneficiary amount for providing care management and coordination and caregiver education and support services. They can also bill for respite services – up to an annual cap – for Medicare beneficiaries who have an unpaid caregiver.
Clinicians seeking to participate in GUIDE can apply beginning in the fall. The program will run for 8 years beginning July 1, 2024.
Alzheimer’s Association President and CEO Joanne Pike, DrPH, said in a statement that the organization had “advocated for this approach for years, believing it [to be] the key to addressing systemic challenges faced by those with dementia, their families and those who provide them with care and support.”
The John A. Hartford Foundation noted that it also had long pushed for a comprehensive dementia care program. “Comprehensive dementia care supports both the medical and nonmedical needs of patients and their family caregivers,” said Foundation President Terry Fulmer, PhD, RN, FAAN, in a statement.
“Notably and necessarily, the model will help improve equity in access to care for underserved communities by addressing unpaid caregiver needs, including respite services and screening for health-related social needs,” added Dr. Fulmer.
A version of this article first appeared on Medscape.com.
Nursing diploma mill leader sentenced to nearly 2 years
U.S. District Judge Rodney Smith of the Southern District of Florida in Fort Lauderdale recently sentenced Johanah Napoleon, former president of the Palm Beach School of Nursing, to 21 months in prison, according to the Miami Herald . The judge also ordered Ms. Napoleon to pay about $3.5 million. She already paid $2.6 million of it, the Herald reports.
The sentence is “indicative of the seriousness of this crime,” shared Willa Fuller, BSN, RN, executive director of the Florida Nurses Association. “Hopefully, this decision will deter potential perpetrators in the future,” Ms. Fuller said in an email.
Ms. Napoleon was charged in 2021 along with two owners of nursing schools in Maryland and Virginia who worked with her. All pled guilty to selling fake degrees for $6,000-$18,000. The Florida Board of Nursing had previously shut down the Palm Beach school in 2017 as a result of its students’ low passing rate on the national licensing exam.
A tip related to the Maryland case led to federal charges in January against 25 owners, operators, and employees of the Palm Beach School of Nursing and two other Florida nursing schools for selling thousands of fake nursing degrees. Those who were charged operated in Delaware, New York, New Jersey, Texas, and Florida.
Five of those 25 defendants will be sentenced on July 27 in a federal district court in Fort Lauderdale after pleading guilty in May to wire fraud conspiracy, according to the U.S. Attorney for the Southern District of Florida. They each face up to 20 years in federal prison.
Purchasers of the fake associate or bachelor’s degrees received transcripts showing that they completed coursework. Some 2,800 of the buyers passed the national nursing licensing exam to become registered nurses and licensed practice nurses/vocational nurses in hospitals, nursing homes, and Veterans Affairs medical centers around the country, according to The New York Times.
Ms. Napoleon’s attorney, Joel DeFabio, said in an interview that he requested a lower sentence than the 4 years recommended in sentencing guidelines because Ms. Napoleon pled guilty quickly and cooperated with the federal investigation.
Mr. DeFabio said that Ms. Napoleon will appear as the government’s witness in a trial in November against Gail Russ, who is one defendant, along with 13 others in the case involving the Palm Beach School of Nursing.
Meanwhile, state nursing boards have been trying to locate nurses who received the fake degrees. In March, the New York nursing board told 903 nurses to either surrender their licenses or prove they had the appropriate education. The board estimated that another 2,300 licensees from the Florida schools had pending applications.
Some nurses who received fake diplomas are pushing back. Attorneys for nurses in Georgia and Pennsylvania claim that their clients were either victims or in some cases, have legitimate credentials.
“The quality of nursing education as well as protection of applicants from these harmful schemes is essential to maintaining the strict standards of the nursing profession,” Ms. Fuller said.
A version of this article appeared on Medscape.com.
U.S. District Judge Rodney Smith of the Southern District of Florida in Fort Lauderdale recently sentenced Johanah Napoleon, former president of the Palm Beach School of Nursing, to 21 months in prison, according to the Miami Herald . The judge also ordered Ms. Napoleon to pay about $3.5 million. She already paid $2.6 million of it, the Herald reports.
The sentence is “indicative of the seriousness of this crime,” shared Willa Fuller, BSN, RN, executive director of the Florida Nurses Association. “Hopefully, this decision will deter potential perpetrators in the future,” Ms. Fuller said in an email.
Ms. Napoleon was charged in 2021 along with two owners of nursing schools in Maryland and Virginia who worked with her. All pled guilty to selling fake degrees for $6,000-$18,000. The Florida Board of Nursing had previously shut down the Palm Beach school in 2017 as a result of its students’ low passing rate on the national licensing exam.
A tip related to the Maryland case led to federal charges in January against 25 owners, operators, and employees of the Palm Beach School of Nursing and two other Florida nursing schools for selling thousands of fake nursing degrees. Those who were charged operated in Delaware, New York, New Jersey, Texas, and Florida.
Five of those 25 defendants will be sentenced on July 27 in a federal district court in Fort Lauderdale after pleading guilty in May to wire fraud conspiracy, according to the U.S. Attorney for the Southern District of Florida. They each face up to 20 years in federal prison.
Purchasers of the fake associate or bachelor’s degrees received transcripts showing that they completed coursework. Some 2,800 of the buyers passed the national nursing licensing exam to become registered nurses and licensed practice nurses/vocational nurses in hospitals, nursing homes, and Veterans Affairs medical centers around the country, according to The New York Times.
Ms. Napoleon’s attorney, Joel DeFabio, said in an interview that he requested a lower sentence than the 4 years recommended in sentencing guidelines because Ms. Napoleon pled guilty quickly and cooperated with the federal investigation.
Mr. DeFabio said that Ms. Napoleon will appear as the government’s witness in a trial in November against Gail Russ, who is one defendant, along with 13 others in the case involving the Palm Beach School of Nursing.
Meanwhile, state nursing boards have been trying to locate nurses who received the fake degrees. In March, the New York nursing board told 903 nurses to either surrender their licenses or prove they had the appropriate education. The board estimated that another 2,300 licensees from the Florida schools had pending applications.
Some nurses who received fake diplomas are pushing back. Attorneys for nurses in Georgia and Pennsylvania claim that their clients were either victims or in some cases, have legitimate credentials.
“The quality of nursing education as well as protection of applicants from these harmful schemes is essential to maintaining the strict standards of the nursing profession,” Ms. Fuller said.
A version of this article appeared on Medscape.com.
U.S. District Judge Rodney Smith of the Southern District of Florida in Fort Lauderdale recently sentenced Johanah Napoleon, former president of the Palm Beach School of Nursing, to 21 months in prison, according to the Miami Herald . The judge also ordered Ms. Napoleon to pay about $3.5 million. She already paid $2.6 million of it, the Herald reports.
The sentence is “indicative of the seriousness of this crime,” shared Willa Fuller, BSN, RN, executive director of the Florida Nurses Association. “Hopefully, this decision will deter potential perpetrators in the future,” Ms. Fuller said in an email.
Ms. Napoleon was charged in 2021 along with two owners of nursing schools in Maryland and Virginia who worked with her. All pled guilty to selling fake degrees for $6,000-$18,000. The Florida Board of Nursing had previously shut down the Palm Beach school in 2017 as a result of its students’ low passing rate on the national licensing exam.
A tip related to the Maryland case led to federal charges in January against 25 owners, operators, and employees of the Palm Beach School of Nursing and two other Florida nursing schools for selling thousands of fake nursing degrees. Those who were charged operated in Delaware, New York, New Jersey, Texas, and Florida.
Five of those 25 defendants will be sentenced on July 27 in a federal district court in Fort Lauderdale after pleading guilty in May to wire fraud conspiracy, according to the U.S. Attorney for the Southern District of Florida. They each face up to 20 years in federal prison.
Purchasers of the fake associate or bachelor’s degrees received transcripts showing that they completed coursework. Some 2,800 of the buyers passed the national nursing licensing exam to become registered nurses and licensed practice nurses/vocational nurses in hospitals, nursing homes, and Veterans Affairs medical centers around the country, according to The New York Times.
Ms. Napoleon’s attorney, Joel DeFabio, said in an interview that he requested a lower sentence than the 4 years recommended in sentencing guidelines because Ms. Napoleon pled guilty quickly and cooperated with the federal investigation.
Mr. DeFabio said that Ms. Napoleon will appear as the government’s witness in a trial in November against Gail Russ, who is one defendant, along with 13 others in the case involving the Palm Beach School of Nursing.
Meanwhile, state nursing boards have been trying to locate nurses who received the fake degrees. In March, the New York nursing board told 903 nurses to either surrender their licenses or prove they had the appropriate education. The board estimated that another 2,300 licensees from the Florida schools had pending applications.
Some nurses who received fake diplomas are pushing back. Attorneys for nurses in Georgia and Pennsylvania claim that their clients were either victims or in some cases, have legitimate credentials.
“The quality of nursing education as well as protection of applicants from these harmful schemes is essential to maintaining the strict standards of the nursing profession,” Ms. Fuller said.
A version of this article appeared on Medscape.com.
Most Americans in favor of regulated therapeutic psychedelics
It is a surprisingly large percentage, said officials at the University of California, Berkeley, Center for the Science of Psychedelics, which conducted the online survey of 1,500 registered voters in early June.
“That is a stunning number,” said Michael Pollan, cofounder of the center, and author of “How to Change Your Mind,” a book that explored potential uses of psychedelics.
In a briefing with reporters, Mr. Pollan said that he believes the large support base, in part, reflects campaigns that have “been successful by highlighting the effectiveness of psychedelics as therapy for mental illness.”
However, the poll also showed that 61% of voters said that they do not perceive psychedelics as “good for society,” and 69% do not perceive them as “something for people like me.”
These negative sentiments “suggest a fragile kind of support – the kind of support where you’re only hearing one side of the story,” said Mr. Pollan.
Still, poll respondents supported other potential policy changes, including 56% in support of the U.S. Food and Drug Administration vetting and approving psychedelics so they could be available by prescription.
50% have tried psychedelics
Almost 80% said that it should be easier for researchers to study psychedelics, and just under one-half said that they backed removing criminal penalties for personal use and possession.
The poll results also show that almost half of respondents had heard about psychedelics recently, with 48% saying they had heard about the drugs’ use in treating mental illness.
Respondents who were most familiar with and positive about psychedelics tended to be White, male, aged 30-50 years, liberal, highly educated, living in a Western state, and have little to no religious or spiritual practice.
Overall, 52% of survey respondents said that they or someone close to them had used a psychedelic, with almost half of that use coming in the past 5 years. Some 40% said that the use had been more than a decade ago.
Almost three-quarters of psychedelic use was reported as recreational, but the second-biggest category was therapeutic use at 39%. About one-third of respondents said that they or someone close to them had microdosed.
Conservative voters had lower levels of awareness and first-degree connection use as well as the least amount of support for regulated therapeutic use, with only 45% saying they would back such a policy, compared with 80% of liberal voters and 66% of moderate voters.
Black individuals were the least likely to be familiar with psychedelics: Just 29% said that they had heard a little or a lot about the drugs, compared with 39% of Latinx individuals and 51% of White individuals. And just one-quarter reported first-degree use, compared with half of Latinx individuals and 56% of White individuals.
Who should be eligible?
When asked who should be eligible for treatment with psychedelics, 80% said that they were comfortable with its use for those with terminal illnesses. More than two-thirds expressed comfort with the drugs being used to help veterans and people with treatment-resistant depression and anxiety.
Less than one-half of respondents said that psychedelics should be available to everyone older than 21 years. And voters seemed to be less inclined to say psychedelics should be used to treat people with addiction, with just 45% indicating that they were very or somewhat comfortable with that use.
Mr. Pollan said that reflects perhaps some lack of knowledge or education.
“The story about addiction and psychedelics hasn’t gotten out,” he said. “I kind of get that intuitively the idea of using a drug to treat a drug doesn’t sound right to a lot of people. But in fact, there’s good evidence it works,” Mr. Pollan said.
Respondents said that doctors, nurses, and scientists were the most trusted source of information about psychedelics, whereas the FDA received lower confidence. Law enforcement was least trusted by liberals and most trusted by conservatives.
Mr. Pollan noted the reversal in attitudes, with Americans mostly now looking to the scientific and medical establishment for guidance on psychedelics.
“We went from a counterculture drug to something that is being taken seriously by scientists as a potential therapy,” he said.
The poll’s margin of error was ± 2.5%.
A version of this article first appeared on Medscape.com.
It is a surprisingly large percentage, said officials at the University of California, Berkeley, Center for the Science of Psychedelics, which conducted the online survey of 1,500 registered voters in early June.
“That is a stunning number,” said Michael Pollan, cofounder of the center, and author of “How to Change Your Mind,” a book that explored potential uses of psychedelics.
In a briefing with reporters, Mr. Pollan said that he believes the large support base, in part, reflects campaigns that have “been successful by highlighting the effectiveness of psychedelics as therapy for mental illness.”
However, the poll also showed that 61% of voters said that they do not perceive psychedelics as “good for society,” and 69% do not perceive them as “something for people like me.”
These negative sentiments “suggest a fragile kind of support – the kind of support where you’re only hearing one side of the story,” said Mr. Pollan.
Still, poll respondents supported other potential policy changes, including 56% in support of the U.S. Food and Drug Administration vetting and approving psychedelics so they could be available by prescription.
50% have tried psychedelics
Almost 80% said that it should be easier for researchers to study psychedelics, and just under one-half said that they backed removing criminal penalties for personal use and possession.
The poll results also show that almost half of respondents had heard about psychedelics recently, with 48% saying they had heard about the drugs’ use in treating mental illness.
Respondents who were most familiar with and positive about psychedelics tended to be White, male, aged 30-50 years, liberal, highly educated, living in a Western state, and have little to no religious or spiritual practice.
Overall, 52% of survey respondents said that they or someone close to them had used a psychedelic, with almost half of that use coming in the past 5 years. Some 40% said that the use had been more than a decade ago.
Almost three-quarters of psychedelic use was reported as recreational, but the second-biggest category was therapeutic use at 39%. About one-third of respondents said that they or someone close to them had microdosed.
Conservative voters had lower levels of awareness and first-degree connection use as well as the least amount of support for regulated therapeutic use, with only 45% saying they would back such a policy, compared with 80% of liberal voters and 66% of moderate voters.
Black individuals were the least likely to be familiar with psychedelics: Just 29% said that they had heard a little or a lot about the drugs, compared with 39% of Latinx individuals and 51% of White individuals. And just one-quarter reported first-degree use, compared with half of Latinx individuals and 56% of White individuals.
Who should be eligible?
When asked who should be eligible for treatment with psychedelics, 80% said that they were comfortable with its use for those with terminal illnesses. More than two-thirds expressed comfort with the drugs being used to help veterans and people with treatment-resistant depression and anxiety.
Less than one-half of respondents said that psychedelics should be available to everyone older than 21 years. And voters seemed to be less inclined to say psychedelics should be used to treat people with addiction, with just 45% indicating that they were very or somewhat comfortable with that use.
Mr. Pollan said that reflects perhaps some lack of knowledge or education.
“The story about addiction and psychedelics hasn’t gotten out,” he said. “I kind of get that intuitively the idea of using a drug to treat a drug doesn’t sound right to a lot of people. But in fact, there’s good evidence it works,” Mr. Pollan said.
Respondents said that doctors, nurses, and scientists were the most trusted source of information about psychedelics, whereas the FDA received lower confidence. Law enforcement was least trusted by liberals and most trusted by conservatives.
Mr. Pollan noted the reversal in attitudes, with Americans mostly now looking to the scientific and medical establishment for guidance on psychedelics.
“We went from a counterculture drug to something that is being taken seriously by scientists as a potential therapy,” he said.
The poll’s margin of error was ± 2.5%.
A version of this article first appeared on Medscape.com.
It is a surprisingly large percentage, said officials at the University of California, Berkeley, Center for the Science of Psychedelics, which conducted the online survey of 1,500 registered voters in early June.
“That is a stunning number,” said Michael Pollan, cofounder of the center, and author of “How to Change Your Mind,” a book that explored potential uses of psychedelics.
In a briefing with reporters, Mr. Pollan said that he believes the large support base, in part, reflects campaigns that have “been successful by highlighting the effectiveness of psychedelics as therapy for mental illness.”
However, the poll also showed that 61% of voters said that they do not perceive psychedelics as “good for society,” and 69% do not perceive them as “something for people like me.”
These negative sentiments “suggest a fragile kind of support – the kind of support where you’re only hearing one side of the story,” said Mr. Pollan.
Still, poll respondents supported other potential policy changes, including 56% in support of the U.S. Food and Drug Administration vetting and approving psychedelics so they could be available by prescription.
50% have tried psychedelics
Almost 80% said that it should be easier for researchers to study psychedelics, and just under one-half said that they backed removing criminal penalties for personal use and possession.
The poll results also show that almost half of respondents had heard about psychedelics recently, with 48% saying they had heard about the drugs’ use in treating mental illness.
Respondents who were most familiar with and positive about psychedelics tended to be White, male, aged 30-50 years, liberal, highly educated, living in a Western state, and have little to no religious or spiritual practice.
Overall, 52% of survey respondents said that they or someone close to them had used a psychedelic, with almost half of that use coming in the past 5 years. Some 40% said that the use had been more than a decade ago.
Almost three-quarters of psychedelic use was reported as recreational, but the second-biggest category was therapeutic use at 39%. About one-third of respondents said that they or someone close to them had microdosed.
Conservative voters had lower levels of awareness and first-degree connection use as well as the least amount of support for regulated therapeutic use, with only 45% saying they would back such a policy, compared with 80% of liberal voters and 66% of moderate voters.
Black individuals were the least likely to be familiar with psychedelics: Just 29% said that they had heard a little or a lot about the drugs, compared with 39% of Latinx individuals and 51% of White individuals. And just one-quarter reported first-degree use, compared with half of Latinx individuals and 56% of White individuals.
Who should be eligible?
When asked who should be eligible for treatment with psychedelics, 80% said that they were comfortable with its use for those with terminal illnesses. More than two-thirds expressed comfort with the drugs being used to help veterans and people with treatment-resistant depression and anxiety.
Less than one-half of respondents said that psychedelics should be available to everyone older than 21 years. And voters seemed to be less inclined to say psychedelics should be used to treat people with addiction, with just 45% indicating that they were very or somewhat comfortable with that use.
Mr. Pollan said that reflects perhaps some lack of knowledge or education.
“The story about addiction and psychedelics hasn’t gotten out,” he said. “I kind of get that intuitively the idea of using a drug to treat a drug doesn’t sound right to a lot of people. But in fact, there’s good evidence it works,” Mr. Pollan said.
Respondents said that doctors, nurses, and scientists were the most trusted source of information about psychedelics, whereas the FDA received lower confidence. Law enforcement was least trusted by liberals and most trusted by conservatives.
Mr. Pollan noted the reversal in attitudes, with Americans mostly now looking to the scientific and medical establishment for guidance on psychedelics.
“We went from a counterculture drug to something that is being taken seriously by scientists as a potential therapy,” he said.
The poll’s margin of error was ± 2.5%.
A version of this article first appeared on Medscape.com.
Case report describes pediatric RIME triggered by norovirus
, according to a newly published case report.
Lead author Anna Yasmine Kirkorian, MD, chief of dermatology at Children’s National Hospital in Washington, said she wanted to get the word out in part because it seems like RIME is occurring more frequently. “I do feel like we’re seeing more cases and from a more diverse number of pathogens,” Dr. Kirkorian told this news organization.
There was a decrease in RIME during the early stages of the COVID-19 pandemic when people were isolating more, Dr. Kirkorian said. SARS-CoV-2 has been a trigger for some cases, but she did not find that remarkable, given that respiratory viruses are known RIME precursors. The question is why RIME is being triggered more frequently now that people have essentially gone back to their normal lives, she said.
Dr. Kirkorian and colleagues at Children’s National Hospital and George Washington University, Washington, wrote about a 5-year-old boy with norovirus-triggered RIME in a case report published in Pediatric Dermatology.
RIME – previously known as Mycoplasma pneumoniae–induced rash and mucositis (MIRM) – tends to arise after a viral infection, with upper respiratory viruses such as mycoplasma and Chlamydophila pneumoniae, influenza, and enterovirus among the common triggers. “We think this is actually your own immune system overreacting to a pathogen,” Dr. Kirkorian said in an interview, adding that the mechanism of RIME is still not understood.
While the norovirus discovery was a surprise, it shows that much is still unknown about this rare condition. “I don’t think we know what is usual and what is unusual,” Dr. Kirkorian said.
In this case, the boy swiftly declined, with progressive conjunctivitis, high fever, and rapidly developing mucositis. By the time the 5-year-old got to Children’s National Hospital, he had a spreading, painful rash, including tense vesicles and bullae involving more than 30% of his total body surface area, and areas of denuded skin on both cheeks and the back of his neck.
He had hemorrhagic mucositis of the lips, a large erosion at the urethral meatus, and hemorrhagic conjunctivitis of both eyes with thick yellow crusting on the eyelids.
The clinicians intubated the boy and admitted him to the intensive care unit. He was given a one-time injection of etanercept (25 mg) followed by 8 days of intravenous cyclosporine at a dose of 5 mg per kilogram, divided twice daily, which helped calm the mucositis and stopped the rash from progressing. There is not an accepted protocol or list of evidence-based therapeutics for RIME, Dr. Kirkorian noted.
The severe eye damage required amniotic membrane grafts. The patient was extubated after 9 days but remained in the hospital for a total of 26 days because he needed to receive nutritional support (the mucositis kept him from eating), and for pain control and weaning of sedation.
As the clinicians searched for a potential triggering virus, they came up empty. Results were negative for adenovirus, Epstein Barr virus, cytomegalovirus, herpes simplex, and varicella zoster. But they noted that the child’s household contacts had all been sick a week before with presumed viral gastroenteritis. They decided to run a stool screen and the polymerase chain reaction for norovirus was positive. The boy never had GI symptoms.
Dr. Kirkorian said in the interview that she has seen other RIME cases where a child did not have symptoms associated with the original virus but did have a sudden onset of mucositis.
Although the definition of RIME is evolving, it is defined in part by mucositis in at least two of three areas: the mouth, eyes, and genitals. “Once you have the inflammation of the mucous membranes you should be on alert to think about more serious conditions,” like RIME, said Dr. Kirkorian. “Why does it manifest with the mucositis? I don’t think we know that,” she added.
RIME recurrence has also been vexing for patients, families and clinicians. In May, at the annual Atlantic Dermatology Conference, held in Baltimore, Dr. Kirkorian also discussed an 11-year-old patient who had RIME after SARS-CoV-2 infection early in the pandemic, resulting in a 22-day hospitalization and placement of a peripherally inserted central catheter and a feeding tube. He improved with cyclosporine and was discharged on systemic tacrolimus.
He was fine for several years, until another COVID infection. He again responded to medication. But not long after, an undetermined viral infection triggered another episode of RIME.
Dr. Kirkorian said there is no way to predict recurrence – making a devastating condition all the more worrisome. “Knowing that it might come back and it’s totally haphazard as to what might make it come back – that is very stressful for families,” she said in the interview.
“Some of the most perplexing patients with RIME are those with recurrent disease,” wrote Warren R. Heymann, MD, professor of dermatology and pediatrics at Rowan University, Camden, N.J., wrote in an online column on RIME in the American Academy of Dermatology’s “Dermatology World Insights and Inquiries”.
“Recurrent RIME is of particular interest, given that we could potentially intervene and prevent additional disease,” wrote Camille Introcaso, MD, associate professor of medicine at Rowan University, in response to Dr. Heymann’s remarks. “Although multiple possible mechanisms for the clinical findings of RIME have been proposed, including molecular mimicry between infectious agent proteins and keratinocyte antigens, immune complex deposition, and combinations of medication and infection, the pathophysiology is unknown,” she added.
In the interview, Dr. Kirkorian said that she and colleagues in the Pediatric Dermatology Research Alliance (PeDRA) are trying to assemble more multicenter trials to assess the underlying pathology of RIME, effectiveness of various treatments, and to “find some predictive factors.” Given that RIME is an acute-onset emergency, it is not easy to conduct randomized controlled trials, she added.
Dr. Kirkorian, Dr. Heymann, and Dr. Introcaso report no relevant financial relationships.
, according to a newly published case report.
Lead author Anna Yasmine Kirkorian, MD, chief of dermatology at Children’s National Hospital in Washington, said she wanted to get the word out in part because it seems like RIME is occurring more frequently. “I do feel like we’re seeing more cases and from a more diverse number of pathogens,” Dr. Kirkorian told this news organization.
There was a decrease in RIME during the early stages of the COVID-19 pandemic when people were isolating more, Dr. Kirkorian said. SARS-CoV-2 has been a trigger for some cases, but she did not find that remarkable, given that respiratory viruses are known RIME precursors. The question is why RIME is being triggered more frequently now that people have essentially gone back to their normal lives, she said.
Dr. Kirkorian and colleagues at Children’s National Hospital and George Washington University, Washington, wrote about a 5-year-old boy with norovirus-triggered RIME in a case report published in Pediatric Dermatology.
RIME – previously known as Mycoplasma pneumoniae–induced rash and mucositis (MIRM) – tends to arise after a viral infection, with upper respiratory viruses such as mycoplasma and Chlamydophila pneumoniae, influenza, and enterovirus among the common triggers. “We think this is actually your own immune system overreacting to a pathogen,” Dr. Kirkorian said in an interview, adding that the mechanism of RIME is still not understood.
While the norovirus discovery was a surprise, it shows that much is still unknown about this rare condition. “I don’t think we know what is usual and what is unusual,” Dr. Kirkorian said.
In this case, the boy swiftly declined, with progressive conjunctivitis, high fever, and rapidly developing mucositis. By the time the 5-year-old got to Children’s National Hospital, he had a spreading, painful rash, including tense vesicles and bullae involving more than 30% of his total body surface area, and areas of denuded skin on both cheeks and the back of his neck.
He had hemorrhagic mucositis of the lips, a large erosion at the urethral meatus, and hemorrhagic conjunctivitis of both eyes with thick yellow crusting on the eyelids.
The clinicians intubated the boy and admitted him to the intensive care unit. He was given a one-time injection of etanercept (25 mg) followed by 8 days of intravenous cyclosporine at a dose of 5 mg per kilogram, divided twice daily, which helped calm the mucositis and stopped the rash from progressing. There is not an accepted protocol or list of evidence-based therapeutics for RIME, Dr. Kirkorian noted.
The severe eye damage required amniotic membrane grafts. The patient was extubated after 9 days but remained in the hospital for a total of 26 days because he needed to receive nutritional support (the mucositis kept him from eating), and for pain control and weaning of sedation.
As the clinicians searched for a potential triggering virus, they came up empty. Results were negative for adenovirus, Epstein Barr virus, cytomegalovirus, herpes simplex, and varicella zoster. But they noted that the child’s household contacts had all been sick a week before with presumed viral gastroenteritis. They decided to run a stool screen and the polymerase chain reaction for norovirus was positive. The boy never had GI symptoms.
Dr. Kirkorian said in the interview that she has seen other RIME cases where a child did not have symptoms associated with the original virus but did have a sudden onset of mucositis.
Although the definition of RIME is evolving, it is defined in part by mucositis in at least two of three areas: the mouth, eyes, and genitals. “Once you have the inflammation of the mucous membranes you should be on alert to think about more serious conditions,” like RIME, said Dr. Kirkorian. “Why does it manifest with the mucositis? I don’t think we know that,” she added.
RIME recurrence has also been vexing for patients, families and clinicians. In May, at the annual Atlantic Dermatology Conference, held in Baltimore, Dr. Kirkorian also discussed an 11-year-old patient who had RIME after SARS-CoV-2 infection early in the pandemic, resulting in a 22-day hospitalization and placement of a peripherally inserted central catheter and a feeding tube. He improved with cyclosporine and was discharged on systemic tacrolimus.
He was fine for several years, until another COVID infection. He again responded to medication. But not long after, an undetermined viral infection triggered another episode of RIME.
Dr. Kirkorian said there is no way to predict recurrence – making a devastating condition all the more worrisome. “Knowing that it might come back and it’s totally haphazard as to what might make it come back – that is very stressful for families,” she said in the interview.
“Some of the most perplexing patients with RIME are those with recurrent disease,” wrote Warren R. Heymann, MD, professor of dermatology and pediatrics at Rowan University, Camden, N.J., wrote in an online column on RIME in the American Academy of Dermatology’s “Dermatology World Insights and Inquiries”.
“Recurrent RIME is of particular interest, given that we could potentially intervene and prevent additional disease,” wrote Camille Introcaso, MD, associate professor of medicine at Rowan University, in response to Dr. Heymann’s remarks. “Although multiple possible mechanisms for the clinical findings of RIME have been proposed, including molecular mimicry between infectious agent proteins and keratinocyte antigens, immune complex deposition, and combinations of medication and infection, the pathophysiology is unknown,” she added.
In the interview, Dr. Kirkorian said that she and colleagues in the Pediatric Dermatology Research Alliance (PeDRA) are trying to assemble more multicenter trials to assess the underlying pathology of RIME, effectiveness of various treatments, and to “find some predictive factors.” Given that RIME is an acute-onset emergency, it is not easy to conduct randomized controlled trials, she added.
Dr. Kirkorian, Dr. Heymann, and Dr. Introcaso report no relevant financial relationships.
, according to a newly published case report.
Lead author Anna Yasmine Kirkorian, MD, chief of dermatology at Children’s National Hospital in Washington, said she wanted to get the word out in part because it seems like RIME is occurring more frequently. “I do feel like we’re seeing more cases and from a more diverse number of pathogens,” Dr. Kirkorian told this news organization.
There was a decrease in RIME during the early stages of the COVID-19 pandemic when people were isolating more, Dr. Kirkorian said. SARS-CoV-2 has been a trigger for some cases, but she did not find that remarkable, given that respiratory viruses are known RIME precursors. The question is why RIME is being triggered more frequently now that people have essentially gone back to their normal lives, she said.
Dr. Kirkorian and colleagues at Children’s National Hospital and George Washington University, Washington, wrote about a 5-year-old boy with norovirus-triggered RIME in a case report published in Pediatric Dermatology.
RIME – previously known as Mycoplasma pneumoniae–induced rash and mucositis (MIRM) – tends to arise after a viral infection, with upper respiratory viruses such as mycoplasma and Chlamydophila pneumoniae, influenza, and enterovirus among the common triggers. “We think this is actually your own immune system overreacting to a pathogen,” Dr. Kirkorian said in an interview, adding that the mechanism of RIME is still not understood.
While the norovirus discovery was a surprise, it shows that much is still unknown about this rare condition. “I don’t think we know what is usual and what is unusual,” Dr. Kirkorian said.
In this case, the boy swiftly declined, with progressive conjunctivitis, high fever, and rapidly developing mucositis. By the time the 5-year-old got to Children’s National Hospital, he had a spreading, painful rash, including tense vesicles and bullae involving more than 30% of his total body surface area, and areas of denuded skin on both cheeks and the back of his neck.
He had hemorrhagic mucositis of the lips, a large erosion at the urethral meatus, and hemorrhagic conjunctivitis of both eyes with thick yellow crusting on the eyelids.
The clinicians intubated the boy and admitted him to the intensive care unit. He was given a one-time injection of etanercept (25 mg) followed by 8 days of intravenous cyclosporine at a dose of 5 mg per kilogram, divided twice daily, which helped calm the mucositis and stopped the rash from progressing. There is not an accepted protocol or list of evidence-based therapeutics for RIME, Dr. Kirkorian noted.
The severe eye damage required amniotic membrane grafts. The patient was extubated after 9 days but remained in the hospital for a total of 26 days because he needed to receive nutritional support (the mucositis kept him from eating), and for pain control and weaning of sedation.
As the clinicians searched for a potential triggering virus, they came up empty. Results were negative for adenovirus, Epstein Barr virus, cytomegalovirus, herpes simplex, and varicella zoster. But they noted that the child’s household contacts had all been sick a week before with presumed viral gastroenteritis. They decided to run a stool screen and the polymerase chain reaction for norovirus was positive. The boy never had GI symptoms.
Dr. Kirkorian said in the interview that she has seen other RIME cases where a child did not have symptoms associated with the original virus but did have a sudden onset of mucositis.
Although the definition of RIME is evolving, it is defined in part by mucositis in at least two of three areas: the mouth, eyes, and genitals. “Once you have the inflammation of the mucous membranes you should be on alert to think about more serious conditions,” like RIME, said Dr. Kirkorian. “Why does it manifest with the mucositis? I don’t think we know that,” she added.
RIME recurrence has also been vexing for patients, families and clinicians. In May, at the annual Atlantic Dermatology Conference, held in Baltimore, Dr. Kirkorian also discussed an 11-year-old patient who had RIME after SARS-CoV-2 infection early in the pandemic, resulting in a 22-day hospitalization and placement of a peripherally inserted central catheter and a feeding tube. He improved with cyclosporine and was discharged on systemic tacrolimus.
He was fine for several years, until another COVID infection. He again responded to medication. But not long after, an undetermined viral infection triggered another episode of RIME.
Dr. Kirkorian said there is no way to predict recurrence – making a devastating condition all the more worrisome. “Knowing that it might come back and it’s totally haphazard as to what might make it come back – that is very stressful for families,” she said in the interview.
“Some of the most perplexing patients with RIME are those with recurrent disease,” wrote Warren R. Heymann, MD, professor of dermatology and pediatrics at Rowan University, Camden, N.J., wrote in an online column on RIME in the American Academy of Dermatology’s “Dermatology World Insights and Inquiries”.
“Recurrent RIME is of particular interest, given that we could potentially intervene and prevent additional disease,” wrote Camille Introcaso, MD, associate professor of medicine at Rowan University, in response to Dr. Heymann’s remarks. “Although multiple possible mechanisms for the clinical findings of RIME have been proposed, including molecular mimicry between infectious agent proteins and keratinocyte antigens, immune complex deposition, and combinations of medication and infection, the pathophysiology is unknown,” she added.
In the interview, Dr. Kirkorian said that she and colleagues in the Pediatric Dermatology Research Alliance (PeDRA) are trying to assemble more multicenter trials to assess the underlying pathology of RIME, effectiveness of various treatments, and to “find some predictive factors.” Given that RIME is an acute-onset emergency, it is not easy to conduct randomized controlled trials, she added.
Dr. Kirkorian, Dr. Heymann, and Dr. Introcaso report no relevant financial relationships.
Study finds big growth in advanced-practice clinicians in Medicare dermatology
A .
Researchers from the University of Texas MD Anderson Cancer Center, Houston, and the University of Pennsylvania, Philadelphia, reported in JAMA Dermatology that in 2013 APCs made up 28% of the dermatology clinician workforce. By 2020, they made up 37% of the dermatology clinicians giving care to Medicare beneficiaries.
Retrospective cohort study
APCs provided care in 15.5% of dermatology office visits in 2013 and 27.4% in 2020 (P =.02), the authors reported. “By 2020, more than one in four dermatology visits for patients with Medicare were delivered by APCs,” wrote the authors, led by Mackenzie R. Wehner, MD, MPhil, assistant professor of dermatology and health services research at MD Anderson.
“Everyone in dermatology is aware of the increasing adoption of advanced practice clinicians in the field,” Justin D. Arnold, MD, MMSc, a 3rd-year dermatology resident at the University of California, Irvine, said in an interview. “However, seeing how quickly this happening and the absolute number of these clinicians is still startling,” said Dr. Arnold, who in 2022 published a research letter in JAMA Dermatology on the impact of physician assistants in dermatology.
In that study, he and his coauthors reported that the PA workforce in dermatology was growing faster than in other specialties.
In the current study, Dr. Wehner and her colleagues identified 8,444 dermatology APCs and 14,402 physician dermatologists who provided 109.3 million Medicare office visits from 2013 to 2020. More than 80% of the procedures were performed by physicians, but APCs appeared to increasingly be taking on more of the procedural load.
Over the study period, APCs had an average annual increase of 12.6% in the number of premalignant lesion destructions performed; physicians saw an average 1.4% decline. For skin biopsies, APCs performed 11.7% more per year on average, compared with a 1.4% drop for physicians.
“This data is not surprising given most agree that skin biopsies and destruction of premalignant lesions are well within the scope of practice of APCs,” Dr. Arnold told this news organization.
The authors also reported that, while most APCs – similar to physician dermatologists – practice in metropolitan areas, they are working in other locations also. Slightly more than half of dermatology clinicians in micropolitan areas are APCs, and in rural areas, 88% of clinicians are APCs, Dr. Wehner and colleagues found.
APCs may be filling a gap in rural areas for Medicare patients, said Dr. Arnold, but, he added, “it is unclear if dermatology APCs are growing as quickly in practices that predominantly accept Medicaid and if dermatology APCs are expanding access to these populations.”
Dr. Arnold said he expected the number of APCs in dermatology to continue growing, serving commercially insured patients, as well. “There are a multitude of potential reasons for more APCs in dermatology, including difficulty recruiting dermatologists in rural communities, financial motivators, and the expansion of private equity, and the increasing acceptance of these clinicians within medicine and by patients.”
APCs can provide good-quality care if they are properly trained and supervised, said Dr. Arnold, adding that he is concerned, however, that the training and supervision is not being provided. “This study provides further evidence that dermatologists, and national dermatology organizations such as the AAD [American Academy of Dermatology], need to take a more active role in the leadership of APC training,” he said.
Dermatology, he noted, “would benefit from consensus guidelines on clinical competencies for dermatology APCs,” similar to an effort by the American College of Cardiology.
A review* published online in July noted that, compared with dermatologists, some data suggest that non-physician operators (NPOs) may have a higher rate of adverse events when performing aesthetic procedures, according to the authors of the review, led by Shelby L. Kubicki, MD, of the department of dermatology at the UTHealth Science Center in Houston. There is no mandatory reporting of complications for nonphysician providers, so the authors relied on data from cosmetic-focused practices, medical spas, and a survey by the American Society of Dermatologic Surgery of consumers and its members. More than half of the responding physicians “reported treating complications of a cosmetic procedure performed by an NPO,” the authors wrote.
They also found higher rates of burns and discoloration among patients who were treated by NPOs. The injuries occurred primarily at medical spas.
“Although NPOs may help to meet the rising demand for dermatologic procedures, care should still be taken to prioritize patient safety and outcomes above all else, including financial profits and revenues,” the authors wrote.
Dr. Wehner and her colleagues report no relevant financial relationships. Their study research was supported, in part, by a Cancer Center Support Grant and by the Cancer Prevention and Research Institute of Texas. Dr. Arnold also reports no relevant financial relationships. No author disclosures or funding information were available for the Clinics in Dermatology paper.
*Correction, 12/8/23: An earlier version of this story misstated the study design.
A .
Researchers from the University of Texas MD Anderson Cancer Center, Houston, and the University of Pennsylvania, Philadelphia, reported in JAMA Dermatology that in 2013 APCs made up 28% of the dermatology clinician workforce. By 2020, they made up 37% of the dermatology clinicians giving care to Medicare beneficiaries.
Retrospective cohort study
APCs provided care in 15.5% of dermatology office visits in 2013 and 27.4% in 2020 (P =.02), the authors reported. “By 2020, more than one in four dermatology visits for patients with Medicare were delivered by APCs,” wrote the authors, led by Mackenzie R. Wehner, MD, MPhil, assistant professor of dermatology and health services research at MD Anderson.
“Everyone in dermatology is aware of the increasing adoption of advanced practice clinicians in the field,” Justin D. Arnold, MD, MMSc, a 3rd-year dermatology resident at the University of California, Irvine, said in an interview. “However, seeing how quickly this happening and the absolute number of these clinicians is still startling,” said Dr. Arnold, who in 2022 published a research letter in JAMA Dermatology on the impact of physician assistants in dermatology.
In that study, he and his coauthors reported that the PA workforce in dermatology was growing faster than in other specialties.
In the current study, Dr. Wehner and her colleagues identified 8,444 dermatology APCs and 14,402 physician dermatologists who provided 109.3 million Medicare office visits from 2013 to 2020. More than 80% of the procedures were performed by physicians, but APCs appeared to increasingly be taking on more of the procedural load.
Over the study period, APCs had an average annual increase of 12.6% in the number of premalignant lesion destructions performed; physicians saw an average 1.4% decline. For skin biopsies, APCs performed 11.7% more per year on average, compared with a 1.4% drop for physicians.
“This data is not surprising given most agree that skin biopsies and destruction of premalignant lesions are well within the scope of practice of APCs,” Dr. Arnold told this news organization.
The authors also reported that, while most APCs – similar to physician dermatologists – practice in metropolitan areas, they are working in other locations also. Slightly more than half of dermatology clinicians in micropolitan areas are APCs, and in rural areas, 88% of clinicians are APCs, Dr. Wehner and colleagues found.
APCs may be filling a gap in rural areas for Medicare patients, said Dr. Arnold, but, he added, “it is unclear if dermatology APCs are growing as quickly in practices that predominantly accept Medicaid and if dermatology APCs are expanding access to these populations.”
Dr. Arnold said he expected the number of APCs in dermatology to continue growing, serving commercially insured patients, as well. “There are a multitude of potential reasons for more APCs in dermatology, including difficulty recruiting dermatologists in rural communities, financial motivators, and the expansion of private equity, and the increasing acceptance of these clinicians within medicine and by patients.”
APCs can provide good-quality care if they are properly trained and supervised, said Dr. Arnold, adding that he is concerned, however, that the training and supervision is not being provided. “This study provides further evidence that dermatologists, and national dermatology organizations such as the AAD [American Academy of Dermatology], need to take a more active role in the leadership of APC training,” he said.
Dermatology, he noted, “would benefit from consensus guidelines on clinical competencies for dermatology APCs,” similar to an effort by the American College of Cardiology.
A review* published online in July noted that, compared with dermatologists, some data suggest that non-physician operators (NPOs) may have a higher rate of adverse events when performing aesthetic procedures, according to the authors of the review, led by Shelby L. Kubicki, MD, of the department of dermatology at the UTHealth Science Center in Houston. There is no mandatory reporting of complications for nonphysician providers, so the authors relied on data from cosmetic-focused practices, medical spas, and a survey by the American Society of Dermatologic Surgery of consumers and its members. More than half of the responding physicians “reported treating complications of a cosmetic procedure performed by an NPO,” the authors wrote.
They also found higher rates of burns and discoloration among patients who were treated by NPOs. The injuries occurred primarily at medical spas.
“Although NPOs may help to meet the rising demand for dermatologic procedures, care should still be taken to prioritize patient safety and outcomes above all else, including financial profits and revenues,” the authors wrote.
Dr. Wehner and her colleagues report no relevant financial relationships. Their study research was supported, in part, by a Cancer Center Support Grant and by the Cancer Prevention and Research Institute of Texas. Dr. Arnold also reports no relevant financial relationships. No author disclosures or funding information were available for the Clinics in Dermatology paper.
*Correction, 12/8/23: An earlier version of this story misstated the study design.
A .
Researchers from the University of Texas MD Anderson Cancer Center, Houston, and the University of Pennsylvania, Philadelphia, reported in JAMA Dermatology that in 2013 APCs made up 28% of the dermatology clinician workforce. By 2020, they made up 37% of the dermatology clinicians giving care to Medicare beneficiaries.
Retrospective cohort study
APCs provided care in 15.5% of dermatology office visits in 2013 and 27.4% in 2020 (P =.02), the authors reported. “By 2020, more than one in four dermatology visits for patients with Medicare were delivered by APCs,” wrote the authors, led by Mackenzie R. Wehner, MD, MPhil, assistant professor of dermatology and health services research at MD Anderson.
“Everyone in dermatology is aware of the increasing adoption of advanced practice clinicians in the field,” Justin D. Arnold, MD, MMSc, a 3rd-year dermatology resident at the University of California, Irvine, said in an interview. “However, seeing how quickly this happening and the absolute number of these clinicians is still startling,” said Dr. Arnold, who in 2022 published a research letter in JAMA Dermatology on the impact of physician assistants in dermatology.
In that study, he and his coauthors reported that the PA workforce in dermatology was growing faster than in other specialties.
In the current study, Dr. Wehner and her colleagues identified 8,444 dermatology APCs and 14,402 physician dermatologists who provided 109.3 million Medicare office visits from 2013 to 2020. More than 80% of the procedures were performed by physicians, but APCs appeared to increasingly be taking on more of the procedural load.
Over the study period, APCs had an average annual increase of 12.6% in the number of premalignant lesion destructions performed; physicians saw an average 1.4% decline. For skin biopsies, APCs performed 11.7% more per year on average, compared with a 1.4% drop for physicians.
“This data is not surprising given most agree that skin biopsies and destruction of premalignant lesions are well within the scope of practice of APCs,” Dr. Arnold told this news organization.
The authors also reported that, while most APCs – similar to physician dermatologists – practice in metropolitan areas, they are working in other locations also. Slightly more than half of dermatology clinicians in micropolitan areas are APCs, and in rural areas, 88% of clinicians are APCs, Dr. Wehner and colleagues found.
APCs may be filling a gap in rural areas for Medicare patients, said Dr. Arnold, but, he added, “it is unclear if dermatology APCs are growing as quickly in practices that predominantly accept Medicaid and if dermatology APCs are expanding access to these populations.”
Dr. Arnold said he expected the number of APCs in dermatology to continue growing, serving commercially insured patients, as well. “There are a multitude of potential reasons for more APCs in dermatology, including difficulty recruiting dermatologists in rural communities, financial motivators, and the expansion of private equity, and the increasing acceptance of these clinicians within medicine and by patients.”
APCs can provide good-quality care if they are properly trained and supervised, said Dr. Arnold, adding that he is concerned, however, that the training and supervision is not being provided. “This study provides further evidence that dermatologists, and national dermatology organizations such as the AAD [American Academy of Dermatology], need to take a more active role in the leadership of APC training,” he said.
Dermatology, he noted, “would benefit from consensus guidelines on clinical competencies for dermatology APCs,” similar to an effort by the American College of Cardiology.
A review* published online in July noted that, compared with dermatologists, some data suggest that non-physician operators (NPOs) may have a higher rate of adverse events when performing aesthetic procedures, according to the authors of the review, led by Shelby L. Kubicki, MD, of the department of dermatology at the UTHealth Science Center in Houston. There is no mandatory reporting of complications for nonphysician providers, so the authors relied on data from cosmetic-focused practices, medical spas, and a survey by the American Society of Dermatologic Surgery of consumers and its members. More than half of the responding physicians “reported treating complications of a cosmetic procedure performed by an NPO,” the authors wrote.
They also found higher rates of burns and discoloration among patients who were treated by NPOs. The injuries occurred primarily at medical spas.
“Although NPOs may help to meet the rising demand for dermatologic procedures, care should still be taken to prioritize patient safety and outcomes above all else, including financial profits and revenues,” the authors wrote.
Dr. Wehner and her colleagues report no relevant financial relationships. Their study research was supported, in part, by a Cancer Center Support Grant and by the Cancer Prevention and Research Institute of Texas. Dr. Arnold also reports no relevant financial relationships. No author disclosures or funding information were available for the Clinics in Dermatology paper.
*Correction, 12/8/23: An earlier version of this story misstated the study design.
FROM JAMA DERMATOLOGY
Harvard medical school sued over stolen body part scandal
Plaintiffs include relatives of people whose remains were allegedly stolen and sold. The lawsuit alleges that as many as 400 cadavers may have been trafficked in a multi-year scheme. Details were revealed in a June 13 indictment by the U.S. attorney for the Middle District of Pennsylvania.
“Medical schools like Harvard have a duty to ensure [donated remains] are handled properly and with decency and to ensure they are used for their intended purpose of scientific study,” attorney Jeff Catalano said in a statement.
“I do think Harvard has that duty,” said Arthur Caplan, PhD, director, Division of Medical Ethics, New York University. But, he added, “I will say there’s not much they can do when employees set out to systematically undermine them.”
The indictment alleges that from 2018 through August 2022, Harvard morgue manager Cedric Lodge stole dissected portions of donated cadavers, including heads, brains, skin, and bones, which were then sold by him and his wife, Denise Lodge, to Katrina Maclean, owner of Kat’s Creepy Creations, Peabody, Mass. Ms. Maclean allegedly sold human remains to Joshua Taylor and Jeremy Pauley, both Pennsylvania residents.
On occasion, Mr. Lodge allowed Ms. Maclean, Mr. Taylor, and others into the morgue to choose which parts they wanted, according to the indictment. Mr. Taylor, Ms. Maclean, and Denise Lodge are all named in the indictment. Mr. Pauley was charged separately.
They each face a maximum of 15 years in prison.
Ms. Maclean allegedly bought two dissected faces for $600 and shipped human skin to Mr. Pauley to be made into leather; Mr. Pauley then eventually shipped the “tanned human skin” back to Ms. Maclean, according to the indictment. Over a 3-year period, Mr. Taylor paid the Lodges some $37,000 for stolen human remains, the indictment charges.
Mr. Pauley also purchased human remains from Candace Chapman Scott, who stole them from her employer, a mortuary in Little Rock, Ark. The mortuary received remains for cremation from an area medical school, according to the indictment.
After being notified of the investigation in March, Harvard cooperated fully, the school said in a statement from George Q. Daley, MD, PhD, dean of the Faculty of Medicine.
“We are appalled to learn that something so disturbing could happen on our campus – a community dedicated to healing and serving others,” the statement said. “The reported incidents are a betrayal of HMS and, most importantly, each of the individuals who altruistically chose to will their bodies to HMS through the Anatomical Gift Program to advance medical education and research.”
The U.S. attorney thanked Harvard for its cooperation, saying that it “is also a victim here.”
Dr. Caplan, who also writes an ethics column for this news organization, agrees. The school was betrayed, he said.
“You expect professionalism, integrity on the part of your doctors, on the part of your technicians, on the part of your workforce,” he said. He noted that those expectations are explained in institutions’ codes of ethics and policies.
Harvard said Mr. Lodge had worked in the morgue since 1995 and that he took several leaves: from September 2021 to February 2022, and again starting February 14. The school terminated his employment on May 6.
His duties included intake of anatomic donors’ bodies. He coordinated embalming and oversaw the storage and movement of cadavers to and from teaching labs. When studies were complete, he prepared remains to be transported to and from the external crematorium and, when appropriate, for burial, according to a Harvard fact sheet for families.
The medical school has convened an outside expert panel to evaluate the Anatomical Gift Program and morgue policies and practices. The panel is expected to make its findings public at the end of the summer.
Dr. Caplan said he hoped the committee recommends unannounced audits of cadaver donation programs and medical tissue and bone suppliers, which could help expose illicit diversions. “You need to keep an eye, which no one seems to do because it’s a state issue and it’s not a priority, on that trade in body parts,” he said.
He believes other medical schools will reexamine their donation programs, especially given Harvard’s status.
“With a prominent place like that having this kind of problem, I can’t imagine there’s not a little bit of a scramble at a lot of the body programs to make sure that they know that things are as they should be,” Dr. Caplan said.
A version of this article first appeared on Medscape.com.
Plaintiffs include relatives of people whose remains were allegedly stolen and sold. The lawsuit alleges that as many as 400 cadavers may have been trafficked in a multi-year scheme. Details were revealed in a June 13 indictment by the U.S. attorney for the Middle District of Pennsylvania.
“Medical schools like Harvard have a duty to ensure [donated remains] are handled properly and with decency and to ensure they are used for their intended purpose of scientific study,” attorney Jeff Catalano said in a statement.
“I do think Harvard has that duty,” said Arthur Caplan, PhD, director, Division of Medical Ethics, New York University. But, he added, “I will say there’s not much they can do when employees set out to systematically undermine them.”
The indictment alleges that from 2018 through August 2022, Harvard morgue manager Cedric Lodge stole dissected portions of donated cadavers, including heads, brains, skin, and bones, which were then sold by him and his wife, Denise Lodge, to Katrina Maclean, owner of Kat’s Creepy Creations, Peabody, Mass. Ms. Maclean allegedly sold human remains to Joshua Taylor and Jeremy Pauley, both Pennsylvania residents.
On occasion, Mr. Lodge allowed Ms. Maclean, Mr. Taylor, and others into the morgue to choose which parts they wanted, according to the indictment. Mr. Taylor, Ms. Maclean, and Denise Lodge are all named in the indictment. Mr. Pauley was charged separately.
They each face a maximum of 15 years in prison.
Ms. Maclean allegedly bought two dissected faces for $600 and shipped human skin to Mr. Pauley to be made into leather; Mr. Pauley then eventually shipped the “tanned human skin” back to Ms. Maclean, according to the indictment. Over a 3-year period, Mr. Taylor paid the Lodges some $37,000 for stolen human remains, the indictment charges.
Mr. Pauley also purchased human remains from Candace Chapman Scott, who stole them from her employer, a mortuary in Little Rock, Ark. The mortuary received remains for cremation from an area medical school, according to the indictment.
After being notified of the investigation in March, Harvard cooperated fully, the school said in a statement from George Q. Daley, MD, PhD, dean of the Faculty of Medicine.
“We are appalled to learn that something so disturbing could happen on our campus – a community dedicated to healing and serving others,” the statement said. “The reported incidents are a betrayal of HMS and, most importantly, each of the individuals who altruistically chose to will their bodies to HMS through the Anatomical Gift Program to advance medical education and research.”
The U.S. attorney thanked Harvard for its cooperation, saying that it “is also a victim here.”
Dr. Caplan, who also writes an ethics column for this news organization, agrees. The school was betrayed, he said.
“You expect professionalism, integrity on the part of your doctors, on the part of your technicians, on the part of your workforce,” he said. He noted that those expectations are explained in institutions’ codes of ethics and policies.
Harvard said Mr. Lodge had worked in the morgue since 1995 and that he took several leaves: from September 2021 to February 2022, and again starting February 14. The school terminated his employment on May 6.
His duties included intake of anatomic donors’ bodies. He coordinated embalming and oversaw the storage and movement of cadavers to and from teaching labs. When studies were complete, he prepared remains to be transported to and from the external crematorium and, when appropriate, for burial, according to a Harvard fact sheet for families.
The medical school has convened an outside expert panel to evaluate the Anatomical Gift Program and morgue policies and practices. The panel is expected to make its findings public at the end of the summer.
Dr. Caplan said he hoped the committee recommends unannounced audits of cadaver donation programs and medical tissue and bone suppliers, which could help expose illicit diversions. “You need to keep an eye, which no one seems to do because it’s a state issue and it’s not a priority, on that trade in body parts,” he said.
He believes other medical schools will reexamine their donation programs, especially given Harvard’s status.
“With a prominent place like that having this kind of problem, I can’t imagine there’s not a little bit of a scramble at a lot of the body programs to make sure that they know that things are as they should be,” Dr. Caplan said.
A version of this article first appeared on Medscape.com.
Plaintiffs include relatives of people whose remains were allegedly stolen and sold. The lawsuit alleges that as many as 400 cadavers may have been trafficked in a multi-year scheme. Details were revealed in a June 13 indictment by the U.S. attorney for the Middle District of Pennsylvania.
“Medical schools like Harvard have a duty to ensure [donated remains] are handled properly and with decency and to ensure they are used for their intended purpose of scientific study,” attorney Jeff Catalano said in a statement.
“I do think Harvard has that duty,” said Arthur Caplan, PhD, director, Division of Medical Ethics, New York University. But, he added, “I will say there’s not much they can do when employees set out to systematically undermine them.”
The indictment alleges that from 2018 through August 2022, Harvard morgue manager Cedric Lodge stole dissected portions of donated cadavers, including heads, brains, skin, and bones, which were then sold by him and his wife, Denise Lodge, to Katrina Maclean, owner of Kat’s Creepy Creations, Peabody, Mass. Ms. Maclean allegedly sold human remains to Joshua Taylor and Jeremy Pauley, both Pennsylvania residents.
On occasion, Mr. Lodge allowed Ms. Maclean, Mr. Taylor, and others into the morgue to choose which parts they wanted, according to the indictment. Mr. Taylor, Ms. Maclean, and Denise Lodge are all named in the indictment. Mr. Pauley was charged separately.
They each face a maximum of 15 years in prison.
Ms. Maclean allegedly bought two dissected faces for $600 and shipped human skin to Mr. Pauley to be made into leather; Mr. Pauley then eventually shipped the “tanned human skin” back to Ms. Maclean, according to the indictment. Over a 3-year period, Mr. Taylor paid the Lodges some $37,000 for stolen human remains, the indictment charges.
Mr. Pauley also purchased human remains from Candace Chapman Scott, who stole them from her employer, a mortuary in Little Rock, Ark. The mortuary received remains for cremation from an area medical school, according to the indictment.
After being notified of the investigation in March, Harvard cooperated fully, the school said in a statement from George Q. Daley, MD, PhD, dean of the Faculty of Medicine.
“We are appalled to learn that something so disturbing could happen on our campus – a community dedicated to healing and serving others,” the statement said. “The reported incidents are a betrayal of HMS and, most importantly, each of the individuals who altruistically chose to will their bodies to HMS through the Anatomical Gift Program to advance medical education and research.”
The U.S. attorney thanked Harvard for its cooperation, saying that it “is also a victim here.”
Dr. Caplan, who also writes an ethics column for this news organization, agrees. The school was betrayed, he said.
“You expect professionalism, integrity on the part of your doctors, on the part of your technicians, on the part of your workforce,” he said. He noted that those expectations are explained in institutions’ codes of ethics and policies.
Harvard said Mr. Lodge had worked in the morgue since 1995 and that he took several leaves: from September 2021 to February 2022, and again starting February 14. The school terminated his employment on May 6.
His duties included intake of anatomic donors’ bodies. He coordinated embalming and oversaw the storage and movement of cadavers to and from teaching labs. When studies were complete, he prepared remains to be transported to and from the external crematorium and, when appropriate, for burial, according to a Harvard fact sheet for families.
The medical school has convened an outside expert panel to evaluate the Anatomical Gift Program and morgue policies and practices. The panel is expected to make its findings public at the end of the summer.
Dr. Caplan said he hoped the committee recommends unannounced audits of cadaver donation programs and medical tissue and bone suppliers, which could help expose illicit diversions. “You need to keep an eye, which no one seems to do because it’s a state issue and it’s not a priority, on that trade in body parts,” he said.
He believes other medical schools will reexamine their donation programs, especially given Harvard’s status.
“With a prominent place like that having this kind of problem, I can’t imagine there’s not a little bit of a scramble at a lot of the body programs to make sure that they know that things are as they should be,” Dr. Caplan said.
A version of this article first appeared on Medscape.com.
Did ob.gyn. residencies take a hit from abortion bans?
Emilee Gibson, MD, recently graduated from Southern Illinois University, Springfield, and starts her ob.gyn. residency at Vanderbilt University Medical Center in Nashville, Tenn., later this month. Abortion is permitted in Illinois but banned in Tennessee, a factor she weighed cautiously when she applied for residencies.
Dr. Gibson told this news organization that medical students, not just those interested in ob.gyn., are starting to think more about what it means to move to a state where it might be difficult to access abortion care. “Just from a personal standpoint, that’s a little scary.”
The Supreme Court’s decision to overturn Roe v. Wade abortion rights last June threatened to derail ob.gyns. in training from pursuing the specialty or locating in states that have banned or limited abortion.
, but some industry leaders, residents, and medical students say it may be too early to judge the full impact of the ruling because most students were already far along in their decision and application for a 2023 residency position.
At this point, some ob.gyn. students are planning careers on the basis of whether they have family ties in a particular state, whether limiting their search might hurt their potential to match in a competitive specialty, and whether their faith in the family planning and abortion training being offered by a program outweighs the drawbacks of being in a state with abortion bans or restrictions.
Lucy Brown, MD, a recent graduate of Indiana University, Indianapolis, said in an interview that she’d be “very nervous” about living and practicing in abortion-restricted Indiana if she were ready to start a family.
Dr. Brown said that she mostly limited applications in the recent Match to ob.gyn. residencies in states that protected abortion rights. Though she applied to a program in her home state of Kentucky, she noted that it – along with a program in Missouri – was very low on her rank list because of their abortion restrictions.
Ultimately, Dr. Brown matched at Johns Hopkins University, Baltimore, where she will receive abortion training and assist with abortions throughout her residency. Maryland’s abortion rights status was a big attraction, she said. “Abortion is integrated into every aspect of the education.”
By the numbers
For students applying to residencies this summer, evaluating the state legislative landscape is a little clearer than it was 1 year ago but is still evolving. As of June 1, 56 ob.gyn. residency programs and more than 1,100 medical residents are in states with the most restrictive bans in the country (19% of all programs), according to the Bixby Center for Reproductive Health at the University of California, San Francisco.
In terms of the latest abortion laws: 14 states banned abortion, 2 states banned abortion between 6 and 12 weeks, and 9 states banned abortion between 15 and 22 weeks, whereas abortion is legal in 25 states and Washington, according to a recent analysis by the Kaiser Family Foundation.
The impact on residencies? The Association of American Medical Colleges recently reported a 2% drop in the number of U.S. MD seniors who applied to residencies and a 5% decline in the number of seniors who applied to ob.gyn. residencies. In states where abortion was banned, the number of senior applicants to ob.gyn. programs dropped by more than 10%, according to AAMC’s Research and Action Institute.
“U.S. MD seniors appear, in general, more likely to avoid states where abortions are banned,” said Atul Grover, MD, PhD, executive director of the Research and Action Institute. “That’s a big difference between states where there are abortion bans and gestational limits and states with no bans or limits; it’s almost twice as large,” Dr. Grover said in an interview. “The question is: Was it a 1-year blip or something that will be the beginning of a trend?”
In a statement to this news organization, officials from the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics said that they were aware of the AAMC data but needed to further evaluate the impact of the Dobbs ruling.
A survey released at ACOG’s annual meeting in May found that 58% of third- and fourth-year medical students were unlikely to apply to a residency program in a state with abortion restrictions. Conducted after the Dobbs ruling last year, the survey found that future physicians are choosing where to attend residency according to state abortion policies, indicating that access to abortion care is changing the landscape of medical practice.
“For personal as well as professional reasons, reproductive health care access is now a key factor in residency match decisions as a result of Dobbs,” lead author Ariana Traub, MPH, said. She studies at Emory University, Atlanta, where abortion is restricted.
“Many students, including myself, struggle when trying to decide whether to stay in restricted states where the need is greatest (highest maternal mortality, infant mortality, lower number of physicians), versus going to an unrestricted state” for more comprehensive training and care, Ms. Traub said. “Regardless of this decision, Dobbs and subsequent abortion laws are making students question what matters most and how they can provide the best care.”
In another recently published survey, University of Miami fourth-year student Morgan Levy, MD, MPH, and colleagues found that 77% of students would prefer to apply to a residency program in a state that preserves access to abortion. Ensuring access to those services for themselves or a family member was a key factor, according to the paper published in the Journal of General Internal Medicine.
For Dr. Levy, who recently graduated from a school in abortion-restricted Florida and will soon apply to ob.gyn. residencies, the Dobbs decision made her more committed to becoming an ob.gyn., an interest she’s had since college, she said.
“I do not intend to limit my search,” Dr. Levy said in an interview. “In the states where there are restrictions in place, it’s really important to make sure that people are getting good care,” she said.
Differing perspective
Though survey and anecdotal data show that students and residents expressing hesitation about states with bans or restrictive laws, it appears that most who applied to residency programs during the 2023 Match did not shy away from those states. Almost all the open ob.gyn. residency positions were filled, according to the National Resident Matching Program.
There was no change in how U.S. MD seniors applying for 2023 residency ranked programs on the basis of whether abortion was legal, limited, or banned in the state where a program was based, Donna Lamb, DHSc, MBA, BSN, president and CEO of the NRMP, said.
“We’re seeing what we’ve seen over the past 5 years, and that is a very high fill rate, a very high rate of preference for ob.gyn., and not a heck of a lot of change,” Dr. Lamb said, noting that ob.gyn. programs continue to be very competitive. “We have more applicants than we have positions available,” she said.
In the most recent Match, there were 2,100 applicants (more than half U.S. MD seniors) for about 1,500 slots, with 1,499 initial matches, according to NRMP data. The overall fill rate was 99.7% after the Supplemental Offer and Assistance Program and Electronic Residency Applications process, NRMP reported. The results are similar to what NRMP reported as its previous all-time high year for ob.gyn. placements.
There was a dip in applicants from 2022 to 2023, even though the slots available stayed the same, but it was not markedly different from the previous 5 years, Dr. Lamb said.
“While the Dobbs decision may, indeed, have impacted applicant and application numbers to residency programs, interventions such as signaling may also contribute to the decrease in numbers of applications submitted as well,” AnnaMarie Connolly, MD, ACOG chief of education and academic affairs, and Arthur Ollendorff, MD, APOG president, said in a statement to this news organization.
For the first time in 2022, Match Day applicants were required to “signal” interest in a particular program in an effort to reduce the number of applications and cost to medical students, they noted.
Personal view
When it was time for Dr. Gibson to apply for ob.gyn. residencies, she wondered: Where do you apply in this landscape? But she did not limit her applications: “If I don’t apply to Indiana, Missouri, Tennessee, Wisconsin, Iowa, I’m taking a lot of really great programs off the table.” She did not want to hurt her chances for a match in a competitive specialty, she said.
“Being in Tennessee is going to give me a very different, unique opportunity to hopefully do a lot of advocacy and lobbying and hopefully have my voice heard in maybe a different way than [in Illinois],” Dr. Gibson added.
Cassie Crifase, MPH, a fourth-year student at the University of Wisconsin–Madison applying to ob.gyn. residencies in next year’s Match, said in an interview that she’s concerned about the health risk of living in a state with abortion restrictions. Wisconsin is one of those.
“My list skews toward programs that are in abortion-protected states, but I also am applying to some programs that are in restricted states.” Those states would have to help her meet the Accreditation Council for Graduate Medical Education training requirements. And, she said, she’d want to know if she could still advocate for abortion access in the state.
Sereena Jivraj, a third-year medical student at Texas Christian University in Fort Worth, said that she won’t apply to programs in Alabama, Mississippi, Arkansas, and other nearby states with abortion restrictions. However, Texas is still on her list. “I’m from Texas, my family lives in Texas, and I go to school in Fort Worth, so I have made those connections,” Ms. Jivraj said.
Student advisers generally encourage ob.gyn. hopefuls to apply to 60-100 programs to ensure that they will match, Ms. Jivraj said. “How are you supposed to apply to 100 programs if many of them fall within states with high restrictions?”
What the future holds
Ms. Jivraj said that she’s concerned about what the future holds, especially if the law does not change in Texas. “I don’t want to go to work every day wondering if I’m going to go to jail for something that I say,” she said.
Dr. Crifase has similar fears. “I want to be able to provide the best care for my patients and that would require being able to do those procedures without having to have my first thought be: Is this legal?”
“Things feel very volatile and uncertain,” Pamela Merritt, executive director of the nonprofit Medical Students for Choice in Philadelphia, where abortion is permitted, said. “What we’re asking medical students to do right now is to envision a future in a profession, a lifetime of providing care, where the policies and procedures and standards of the profession are under attack by 26 state legislatures and the federal court system,” she said.
“I don’t think you’re going to see people as willing to take risk.” She added that if someone matches to a program and then has regrets, “You can’t easily jump from residency program to residency program.”
Dr. Levy believes that the impact of the Dobbs decision is “definitely going to be a more common question of applicants to their potential programs.”
Applicants undoubtedly are thinking about how abortion restrictions or bans might affect their own health or that of their partners or families, she said. In a 2022 survey, Dr. Levy and colleagues reported that abortion is not uncommon among physicians, with 11.5% of the 1,566 respondents who had been pregnant saying they had at least one therapeutic abortion.
Students are also considering the potential ramification of a ban on emergency contraception and laws that criminalize physicians’ provision of abortion care, Dr. Levy said. Another complicating factor is individuals’ family ties or roots in specific geographic areas, she said.
Prospective residents will also have a lot of questions about how they will receive family planning training, Dr. Levy commented. “If you’re somewhere that you can’t really provide full-spectrum reproductive health care, then the question will become: How is the program going to provide that training?”
A version of this article first appeared on Medscape.com.
Emilee Gibson, MD, recently graduated from Southern Illinois University, Springfield, and starts her ob.gyn. residency at Vanderbilt University Medical Center in Nashville, Tenn., later this month. Abortion is permitted in Illinois but banned in Tennessee, a factor she weighed cautiously when she applied for residencies.
Dr. Gibson told this news organization that medical students, not just those interested in ob.gyn., are starting to think more about what it means to move to a state where it might be difficult to access abortion care. “Just from a personal standpoint, that’s a little scary.”
The Supreme Court’s decision to overturn Roe v. Wade abortion rights last June threatened to derail ob.gyns. in training from pursuing the specialty or locating in states that have banned or limited abortion.
, but some industry leaders, residents, and medical students say it may be too early to judge the full impact of the ruling because most students were already far along in their decision and application for a 2023 residency position.
At this point, some ob.gyn. students are planning careers on the basis of whether they have family ties in a particular state, whether limiting their search might hurt their potential to match in a competitive specialty, and whether their faith in the family planning and abortion training being offered by a program outweighs the drawbacks of being in a state with abortion bans or restrictions.
Lucy Brown, MD, a recent graduate of Indiana University, Indianapolis, said in an interview that she’d be “very nervous” about living and practicing in abortion-restricted Indiana if she were ready to start a family.
Dr. Brown said that she mostly limited applications in the recent Match to ob.gyn. residencies in states that protected abortion rights. Though she applied to a program in her home state of Kentucky, she noted that it – along with a program in Missouri – was very low on her rank list because of their abortion restrictions.
Ultimately, Dr. Brown matched at Johns Hopkins University, Baltimore, where she will receive abortion training and assist with abortions throughout her residency. Maryland’s abortion rights status was a big attraction, she said. “Abortion is integrated into every aspect of the education.”
By the numbers
For students applying to residencies this summer, evaluating the state legislative landscape is a little clearer than it was 1 year ago but is still evolving. As of June 1, 56 ob.gyn. residency programs and more than 1,100 medical residents are in states with the most restrictive bans in the country (19% of all programs), according to the Bixby Center for Reproductive Health at the University of California, San Francisco.
In terms of the latest abortion laws: 14 states banned abortion, 2 states banned abortion between 6 and 12 weeks, and 9 states banned abortion between 15 and 22 weeks, whereas abortion is legal in 25 states and Washington, according to a recent analysis by the Kaiser Family Foundation.
The impact on residencies? The Association of American Medical Colleges recently reported a 2% drop in the number of U.S. MD seniors who applied to residencies and a 5% decline in the number of seniors who applied to ob.gyn. residencies. In states where abortion was banned, the number of senior applicants to ob.gyn. programs dropped by more than 10%, according to AAMC’s Research and Action Institute.
“U.S. MD seniors appear, in general, more likely to avoid states where abortions are banned,” said Atul Grover, MD, PhD, executive director of the Research and Action Institute. “That’s a big difference between states where there are abortion bans and gestational limits and states with no bans or limits; it’s almost twice as large,” Dr. Grover said in an interview. “The question is: Was it a 1-year blip or something that will be the beginning of a trend?”
In a statement to this news organization, officials from the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics said that they were aware of the AAMC data but needed to further evaluate the impact of the Dobbs ruling.
A survey released at ACOG’s annual meeting in May found that 58% of third- and fourth-year medical students were unlikely to apply to a residency program in a state with abortion restrictions. Conducted after the Dobbs ruling last year, the survey found that future physicians are choosing where to attend residency according to state abortion policies, indicating that access to abortion care is changing the landscape of medical practice.
“For personal as well as professional reasons, reproductive health care access is now a key factor in residency match decisions as a result of Dobbs,” lead author Ariana Traub, MPH, said. She studies at Emory University, Atlanta, where abortion is restricted.
“Many students, including myself, struggle when trying to decide whether to stay in restricted states where the need is greatest (highest maternal mortality, infant mortality, lower number of physicians), versus going to an unrestricted state” for more comprehensive training and care, Ms. Traub said. “Regardless of this decision, Dobbs and subsequent abortion laws are making students question what matters most and how they can provide the best care.”
In another recently published survey, University of Miami fourth-year student Morgan Levy, MD, MPH, and colleagues found that 77% of students would prefer to apply to a residency program in a state that preserves access to abortion. Ensuring access to those services for themselves or a family member was a key factor, according to the paper published in the Journal of General Internal Medicine.
For Dr. Levy, who recently graduated from a school in abortion-restricted Florida and will soon apply to ob.gyn. residencies, the Dobbs decision made her more committed to becoming an ob.gyn., an interest she’s had since college, she said.
“I do not intend to limit my search,” Dr. Levy said in an interview. “In the states where there are restrictions in place, it’s really important to make sure that people are getting good care,” she said.
Differing perspective
Though survey and anecdotal data show that students and residents expressing hesitation about states with bans or restrictive laws, it appears that most who applied to residency programs during the 2023 Match did not shy away from those states. Almost all the open ob.gyn. residency positions were filled, according to the National Resident Matching Program.
There was no change in how U.S. MD seniors applying for 2023 residency ranked programs on the basis of whether abortion was legal, limited, or banned in the state where a program was based, Donna Lamb, DHSc, MBA, BSN, president and CEO of the NRMP, said.
“We’re seeing what we’ve seen over the past 5 years, and that is a very high fill rate, a very high rate of preference for ob.gyn., and not a heck of a lot of change,” Dr. Lamb said, noting that ob.gyn. programs continue to be very competitive. “We have more applicants than we have positions available,” she said.
In the most recent Match, there were 2,100 applicants (more than half U.S. MD seniors) for about 1,500 slots, with 1,499 initial matches, according to NRMP data. The overall fill rate was 99.7% after the Supplemental Offer and Assistance Program and Electronic Residency Applications process, NRMP reported. The results are similar to what NRMP reported as its previous all-time high year for ob.gyn. placements.
There was a dip in applicants from 2022 to 2023, even though the slots available stayed the same, but it was not markedly different from the previous 5 years, Dr. Lamb said.
“While the Dobbs decision may, indeed, have impacted applicant and application numbers to residency programs, interventions such as signaling may also contribute to the decrease in numbers of applications submitted as well,” AnnaMarie Connolly, MD, ACOG chief of education and academic affairs, and Arthur Ollendorff, MD, APOG president, said in a statement to this news organization.
For the first time in 2022, Match Day applicants were required to “signal” interest in a particular program in an effort to reduce the number of applications and cost to medical students, they noted.
Personal view
When it was time for Dr. Gibson to apply for ob.gyn. residencies, she wondered: Where do you apply in this landscape? But she did not limit her applications: “If I don’t apply to Indiana, Missouri, Tennessee, Wisconsin, Iowa, I’m taking a lot of really great programs off the table.” She did not want to hurt her chances for a match in a competitive specialty, she said.
“Being in Tennessee is going to give me a very different, unique opportunity to hopefully do a lot of advocacy and lobbying and hopefully have my voice heard in maybe a different way than [in Illinois],” Dr. Gibson added.
Cassie Crifase, MPH, a fourth-year student at the University of Wisconsin–Madison applying to ob.gyn. residencies in next year’s Match, said in an interview that she’s concerned about the health risk of living in a state with abortion restrictions. Wisconsin is one of those.
“My list skews toward programs that are in abortion-protected states, but I also am applying to some programs that are in restricted states.” Those states would have to help her meet the Accreditation Council for Graduate Medical Education training requirements. And, she said, she’d want to know if she could still advocate for abortion access in the state.
Sereena Jivraj, a third-year medical student at Texas Christian University in Fort Worth, said that she won’t apply to programs in Alabama, Mississippi, Arkansas, and other nearby states with abortion restrictions. However, Texas is still on her list. “I’m from Texas, my family lives in Texas, and I go to school in Fort Worth, so I have made those connections,” Ms. Jivraj said.
Student advisers generally encourage ob.gyn. hopefuls to apply to 60-100 programs to ensure that they will match, Ms. Jivraj said. “How are you supposed to apply to 100 programs if many of them fall within states with high restrictions?”
What the future holds
Ms. Jivraj said that she’s concerned about what the future holds, especially if the law does not change in Texas. “I don’t want to go to work every day wondering if I’m going to go to jail for something that I say,” she said.
Dr. Crifase has similar fears. “I want to be able to provide the best care for my patients and that would require being able to do those procedures without having to have my first thought be: Is this legal?”
“Things feel very volatile and uncertain,” Pamela Merritt, executive director of the nonprofit Medical Students for Choice in Philadelphia, where abortion is permitted, said. “What we’re asking medical students to do right now is to envision a future in a profession, a lifetime of providing care, where the policies and procedures and standards of the profession are under attack by 26 state legislatures and the federal court system,” she said.
“I don’t think you’re going to see people as willing to take risk.” She added that if someone matches to a program and then has regrets, “You can’t easily jump from residency program to residency program.”
Dr. Levy believes that the impact of the Dobbs decision is “definitely going to be a more common question of applicants to their potential programs.”
Applicants undoubtedly are thinking about how abortion restrictions or bans might affect their own health or that of their partners or families, she said. In a 2022 survey, Dr. Levy and colleagues reported that abortion is not uncommon among physicians, with 11.5% of the 1,566 respondents who had been pregnant saying they had at least one therapeutic abortion.
Students are also considering the potential ramification of a ban on emergency contraception and laws that criminalize physicians’ provision of abortion care, Dr. Levy said. Another complicating factor is individuals’ family ties or roots in specific geographic areas, she said.
Prospective residents will also have a lot of questions about how they will receive family planning training, Dr. Levy commented. “If you’re somewhere that you can’t really provide full-spectrum reproductive health care, then the question will become: How is the program going to provide that training?”
A version of this article first appeared on Medscape.com.
Emilee Gibson, MD, recently graduated from Southern Illinois University, Springfield, and starts her ob.gyn. residency at Vanderbilt University Medical Center in Nashville, Tenn., later this month. Abortion is permitted in Illinois but banned in Tennessee, a factor she weighed cautiously when she applied for residencies.
Dr. Gibson told this news organization that medical students, not just those interested in ob.gyn., are starting to think more about what it means to move to a state where it might be difficult to access abortion care. “Just from a personal standpoint, that’s a little scary.”
The Supreme Court’s decision to overturn Roe v. Wade abortion rights last June threatened to derail ob.gyns. in training from pursuing the specialty or locating in states that have banned or limited abortion.
, but some industry leaders, residents, and medical students say it may be too early to judge the full impact of the ruling because most students were already far along in their decision and application for a 2023 residency position.
At this point, some ob.gyn. students are planning careers on the basis of whether they have family ties in a particular state, whether limiting their search might hurt their potential to match in a competitive specialty, and whether their faith in the family planning and abortion training being offered by a program outweighs the drawbacks of being in a state with abortion bans or restrictions.
Lucy Brown, MD, a recent graduate of Indiana University, Indianapolis, said in an interview that she’d be “very nervous” about living and practicing in abortion-restricted Indiana if she were ready to start a family.
Dr. Brown said that she mostly limited applications in the recent Match to ob.gyn. residencies in states that protected abortion rights. Though she applied to a program in her home state of Kentucky, she noted that it – along with a program in Missouri – was very low on her rank list because of their abortion restrictions.
Ultimately, Dr. Brown matched at Johns Hopkins University, Baltimore, where she will receive abortion training and assist with abortions throughout her residency. Maryland’s abortion rights status was a big attraction, she said. “Abortion is integrated into every aspect of the education.”
By the numbers
For students applying to residencies this summer, evaluating the state legislative landscape is a little clearer than it was 1 year ago but is still evolving. As of June 1, 56 ob.gyn. residency programs and more than 1,100 medical residents are in states with the most restrictive bans in the country (19% of all programs), according to the Bixby Center for Reproductive Health at the University of California, San Francisco.
In terms of the latest abortion laws: 14 states banned abortion, 2 states banned abortion between 6 and 12 weeks, and 9 states banned abortion between 15 and 22 weeks, whereas abortion is legal in 25 states and Washington, according to a recent analysis by the Kaiser Family Foundation.
The impact on residencies? The Association of American Medical Colleges recently reported a 2% drop in the number of U.S. MD seniors who applied to residencies and a 5% decline in the number of seniors who applied to ob.gyn. residencies. In states where abortion was banned, the number of senior applicants to ob.gyn. programs dropped by more than 10%, according to AAMC’s Research and Action Institute.
“U.S. MD seniors appear, in general, more likely to avoid states where abortions are banned,” said Atul Grover, MD, PhD, executive director of the Research and Action Institute. “That’s a big difference between states where there are abortion bans and gestational limits and states with no bans or limits; it’s almost twice as large,” Dr. Grover said in an interview. “The question is: Was it a 1-year blip or something that will be the beginning of a trend?”
In a statement to this news organization, officials from the American College of Obstetricians and Gynecologists and the Association of Professors of Gynecology and Obstetrics said that they were aware of the AAMC data but needed to further evaluate the impact of the Dobbs ruling.
A survey released at ACOG’s annual meeting in May found that 58% of third- and fourth-year medical students were unlikely to apply to a residency program in a state with abortion restrictions. Conducted after the Dobbs ruling last year, the survey found that future physicians are choosing where to attend residency according to state abortion policies, indicating that access to abortion care is changing the landscape of medical practice.
“For personal as well as professional reasons, reproductive health care access is now a key factor in residency match decisions as a result of Dobbs,” lead author Ariana Traub, MPH, said. She studies at Emory University, Atlanta, where abortion is restricted.
“Many students, including myself, struggle when trying to decide whether to stay in restricted states where the need is greatest (highest maternal mortality, infant mortality, lower number of physicians), versus going to an unrestricted state” for more comprehensive training and care, Ms. Traub said. “Regardless of this decision, Dobbs and subsequent abortion laws are making students question what matters most and how they can provide the best care.”
In another recently published survey, University of Miami fourth-year student Morgan Levy, MD, MPH, and colleagues found that 77% of students would prefer to apply to a residency program in a state that preserves access to abortion. Ensuring access to those services for themselves or a family member was a key factor, according to the paper published in the Journal of General Internal Medicine.
For Dr. Levy, who recently graduated from a school in abortion-restricted Florida and will soon apply to ob.gyn. residencies, the Dobbs decision made her more committed to becoming an ob.gyn., an interest she’s had since college, she said.
“I do not intend to limit my search,” Dr. Levy said in an interview. “In the states where there are restrictions in place, it’s really important to make sure that people are getting good care,” she said.
Differing perspective
Though survey and anecdotal data show that students and residents expressing hesitation about states with bans or restrictive laws, it appears that most who applied to residency programs during the 2023 Match did not shy away from those states. Almost all the open ob.gyn. residency positions were filled, according to the National Resident Matching Program.
There was no change in how U.S. MD seniors applying for 2023 residency ranked programs on the basis of whether abortion was legal, limited, or banned in the state where a program was based, Donna Lamb, DHSc, MBA, BSN, president and CEO of the NRMP, said.
“We’re seeing what we’ve seen over the past 5 years, and that is a very high fill rate, a very high rate of preference for ob.gyn., and not a heck of a lot of change,” Dr. Lamb said, noting that ob.gyn. programs continue to be very competitive. “We have more applicants than we have positions available,” she said.
In the most recent Match, there were 2,100 applicants (more than half U.S. MD seniors) for about 1,500 slots, with 1,499 initial matches, according to NRMP data. The overall fill rate was 99.7% after the Supplemental Offer and Assistance Program and Electronic Residency Applications process, NRMP reported. The results are similar to what NRMP reported as its previous all-time high year for ob.gyn. placements.
There was a dip in applicants from 2022 to 2023, even though the slots available stayed the same, but it was not markedly different from the previous 5 years, Dr. Lamb said.
“While the Dobbs decision may, indeed, have impacted applicant and application numbers to residency programs, interventions such as signaling may also contribute to the decrease in numbers of applications submitted as well,” AnnaMarie Connolly, MD, ACOG chief of education and academic affairs, and Arthur Ollendorff, MD, APOG president, said in a statement to this news organization.
For the first time in 2022, Match Day applicants were required to “signal” interest in a particular program in an effort to reduce the number of applications and cost to medical students, they noted.
Personal view
When it was time for Dr. Gibson to apply for ob.gyn. residencies, she wondered: Where do you apply in this landscape? But she did not limit her applications: “If I don’t apply to Indiana, Missouri, Tennessee, Wisconsin, Iowa, I’m taking a lot of really great programs off the table.” She did not want to hurt her chances for a match in a competitive specialty, she said.
“Being in Tennessee is going to give me a very different, unique opportunity to hopefully do a lot of advocacy and lobbying and hopefully have my voice heard in maybe a different way than [in Illinois],” Dr. Gibson added.
Cassie Crifase, MPH, a fourth-year student at the University of Wisconsin–Madison applying to ob.gyn. residencies in next year’s Match, said in an interview that she’s concerned about the health risk of living in a state with abortion restrictions. Wisconsin is one of those.
“My list skews toward programs that are in abortion-protected states, but I also am applying to some programs that are in restricted states.” Those states would have to help her meet the Accreditation Council for Graduate Medical Education training requirements. And, she said, she’d want to know if she could still advocate for abortion access in the state.
Sereena Jivraj, a third-year medical student at Texas Christian University in Fort Worth, said that she won’t apply to programs in Alabama, Mississippi, Arkansas, and other nearby states with abortion restrictions. However, Texas is still on her list. “I’m from Texas, my family lives in Texas, and I go to school in Fort Worth, so I have made those connections,” Ms. Jivraj said.
Student advisers generally encourage ob.gyn. hopefuls to apply to 60-100 programs to ensure that they will match, Ms. Jivraj said. “How are you supposed to apply to 100 programs if many of them fall within states with high restrictions?”
What the future holds
Ms. Jivraj said that she’s concerned about what the future holds, especially if the law does not change in Texas. “I don’t want to go to work every day wondering if I’m going to go to jail for something that I say,” she said.
Dr. Crifase has similar fears. “I want to be able to provide the best care for my patients and that would require being able to do those procedures without having to have my first thought be: Is this legal?”
“Things feel very volatile and uncertain,” Pamela Merritt, executive director of the nonprofit Medical Students for Choice in Philadelphia, where abortion is permitted, said. “What we’re asking medical students to do right now is to envision a future in a profession, a lifetime of providing care, where the policies and procedures and standards of the profession are under attack by 26 state legislatures and the federal court system,” she said.
“I don’t think you’re going to see people as willing to take risk.” She added that if someone matches to a program and then has regrets, “You can’t easily jump from residency program to residency program.”
Dr. Levy believes that the impact of the Dobbs decision is “definitely going to be a more common question of applicants to their potential programs.”
Applicants undoubtedly are thinking about how abortion restrictions or bans might affect their own health or that of their partners or families, she said. In a 2022 survey, Dr. Levy and colleagues reported that abortion is not uncommon among physicians, with 11.5% of the 1,566 respondents who had been pregnant saying they had at least one therapeutic abortion.
Students are also considering the potential ramification of a ban on emergency contraception and laws that criminalize physicians’ provision of abortion care, Dr. Levy said. Another complicating factor is individuals’ family ties or roots in specific geographic areas, she said.
Prospective residents will also have a lot of questions about how they will receive family planning training, Dr. Levy commented. “If you’re somewhere that you can’t really provide full-spectrum reproductive health care, then the question will become: How is the program going to provide that training?”
A version of this article first appeared on Medscape.com.